Healthcare Provider Details

I. General information

NPI: 1144156373
Provider Name (Legal Business Name): AUTUMN SMITH
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/23/2026
Last Update Date: 06/23/2026
Certification Date: 06/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

75 HIGHWAY 62 412 STE L
ASH FLAT AR
72513-9629
US

IV. Provider business mailing address

2904 KING ST
JONESBORO AR
72401-5321
US

V. Phone/Fax

Practice location:
  • Phone: 870-243-6292
  • Fax:
Mailing address:
  • Phone: 870-203-9700
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: