MEDICARE: KAYLA BETH INGRAM-SMITH APRN

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	364SA2100X	Acute Care Clinical Nurse Specialist	R071373	AR
2	363LA2100X	Acute Care Nurse Practitioner	A004944	AR

General Provider Information

NPI Number	:	1144771296
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KAYLA BETH INGRAM-SMITH APRN

Provider Business Mailing Address
First Line	:	4301 W MARKHAM ST # 783
Second Line	:
City	:	LITTLE ROCK
State	:	AR
Zip	:	72205-7101
Country	:	US
Telephone Number	:	501-686-8000
Fax Number	:	501-526-5148

Provider Business Practice Location Address
First Line	:	4261 STOCKTON DR STE 100
Second Line	:
City	:	NORTH LITTLE ROCK
State	:	AR
Zip	:	72117-2916
Country	:	US
Telephone Number	:	501-526-5451
Fax Number	:	501-526-5823

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/24/2016
Last Update Date	:	08/07/2023

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