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Smith was born in Pimlico, Middlesex (now London), England the only child of an American merchant from Brooklyn, Charles Edward Smith and his Jamaican wife Corinne Colman. The family was based in Manchester for the first decade of Smith's life, but the family moved to Jamaica when Charles Smith took a job in 1889 with the West India Improvement Company (a financial syndicate involved in extending the Jamaican railroad system). The family lived in Kingston, Jamaica, for several years but traveled between Jamaica, London, and Brooklyn, New York.

By 1893, Smith had moved to Brooklyn, where, at the age of 15, she enrolled at the relatively new Pratt Institute and studied art under the noted artist teacher Arthur Wesley Dow. Her mature drawing style shows clear traces of the visionary qualities of fin-de-siècle Symbolism and the romanticism of the preceding Arts and Crafts movement. While Smith was in art school, her mother died in Jamaica, in 1896. Smith herself was ill on and off during these years and in the end left Pratt in 1897 without a degree and became an illustrator. Her illustration projects in the late 1890s included The Illustrated Verses of William Butler Yeats, a book on the actress Ellen Terry by Bram Stoker, and two of her own books, Widdicombe Fair and Fair Vanity.

Returning to England in 1899 (the year her father died), she became a theatrical designer for a miniature theatre and continued to work as an illustrator. In London, she was taken under the wing of the Lyceum Theatre group led by Ellen Terry (who is said to have given her the nickname 'Pixie'), Henry Irving, and Bram Stoker and traveled with them around the country, working on costumes and stage design. In 1901, she established a studio in London and held a weekly open house for artists, authors, actors, and others involved with the arts.

Smith wrote and illustrated several books about Jamaican folklore, including Annancy Stories (1902) which were about Jamaican versions of tales involving the traditional African folk figure Anansi the Spider. She also continued her illustration work, taking on projects for William Butler Yeats and his brother, the painter Jack Yeats. She illustrated Bram Stoker's last novel, The Lair of the White Worm in 1911, and Ellen Terry's book on Diaghilev's Ballets Russes, The Russian Ballet in 1913. Through a studio known as the London Suffrage Atelier, she contributed artwork to further the cause of women's suffrage in Great Britain.

In 1903, Pamela launched her own magazine under the title The Green Sheaf, with contributions by Yeats, Christopher St John (Christabel Marshall), Cecil French, A. E. (George William Russell), Gordon Craig (Ellen Terry's son), Dorothy Ward, John Todhunter, and others. The Green Sheaf survived for a little over a year, a total of 13 issues.

In 1907, Alfred Stieglitz gave Smith an exhibition of paintings in New York at his Little Galleries of the Photo-Secession (also known as gallery 291), making Smith the first painter to have a show at what had been until then a gallery devoted exclusively to the photographic avant-garde. Stieglitz was intrigued by Smith's synaesthetic sensibility; in this period, Smith would paint visions that came to her while listening to music. The show was successful enough that Stieglitz issued a platinum print portfolio of 22 of her paintings and showed her work twice more, in 1908 and 1909. Some Smith works that did not sell remained with Stieglitz and ended up in the Stieglitz/Georgia O'Keeffe Archive at Yale University.

Yeats introduced Smith to the Hermetic Order of the Golden Dawn, which she joined in 1901 and in the process met Waite. When the Golden Dawn splintered due to personality conflicts, Smith moved with Waite to the Independent and Rectified Rite of the Golden Dawn (or Holy Order of the Golden Dawn). In 1909, Waite commissioned Smith to produce a tarot deck with appeal to the world of art, and the result was the unique Waite-Smith tarot deck. Published by William Rider & Son of London, it has endured as the world's most popular 78-card tarot deck. The innovative cards depict full scenes with figures and symbols on all of the cards including the pips, and Smith's distinctive drawings have become the basis for the design of many subsequent packs.[2]

Apart from book illustration projects and the tarot deck, her art found little in the way of commercial outlets after her early success with Stieglitz in New York. Several beautiful examples of her works done in gouache were collected by her cousin, Sherlock Holmes stage actor William Gillette, and may be found today prominently displayed in the permanent collection at his castle in East Haddam, Connecticut.

In 1911, Smith converted to Catholicism. After the end of the First World War, Smith received an inheritance from an uncle that enabled her to buy a house in Cornwall, an area popular with artists. For income, she established a vacation home for Catholic priests in a neighboring house. She never married, and she died penniless in Bude, Cornwall on 18 September 1951. After her death, all of her personal effects, including her paintings and drawings, were sold at auction to satisfy her debts.