MEDICARE: DEBORAH A. SMITHYMAN PSYD

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	103TC0700X	Clinical Psychologist	10-09P	AR

General Provider Information

NPI Number	:	1952307548
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DEBORAH A. SMITHYMAN PSYD

Provider Business Mailing Address
First Line	:	211 N 34TH ST
Second Line	:
City	:	ROGERS
State	:	AR
Zip	:	72756-0352
Country	:	US
Telephone Number	:	479-202-9956
Fax Number	:	479-202-9956

Provider Business Practice Location Address
First Line	:	211 N 34TH ST
Second Line	:
City	:	ROGERS
State	:	AR
Zip	:	72756-0352
Country	:	US
Telephone Number	:	479-202-9956
Fax Number	:	479-202-9956

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

Provider Enumeration Date	:	06/28/2005
Last Update Date	:	03/13/2013

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