Healthcare Provider Details

I. General information

NPI: 1912839812
Provider Name (Legal Business Name): LACARL SMITH
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/02/2026
Last Update Date: 06/02/2026
Certification Date: 06/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1155 FRONT ST STE 1
CONWAY AR
72032-4373
US

IV. Provider business mailing address

1508 S BOSTON PL APT 2
RUSSELLVILLE AR
72801-7267
US

V. Phone/Fax

Practice location:
  • Phone: 501-358-6698
  • Fax:
Mailing address:
  • Phone: 479-747-0412
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number3823
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: