Healthcare Provider Details

I. General information

NPI: 1619909009
Provider Name (Legal Business Name): STACY M SMALLEY CNM MSN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/07/2006
Last Update Date: 10/30/2024
Certification Date: 10/30/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7001 ROGERS AVE STE 403
FORT SMITH AR
72903-4034
US

IV. Provider business mailing address

7001 ROGERS AVE STE 403
FORT SMITH AR
72903-4034
US

V. Phone/Fax

Practice location:
  • Phone: 479-785-2229
  • Fax: 479-478-6745
Mailing address:
  • Phone: 479-785-2229
  • Fax: 845-353-1987

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code176B00000X
TaxonomyMidwife
License NumberF001316-1
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code176B00000X
TaxonomyMidwife
License NumberM002126
License Number StateAR
# 3
Primary TaxonomyN
Taxonomy Code367A00000X
TaxonomyAdvanced Practice Midwife
License NumberLNM000261
License Number StateCT
# 4
Primary TaxonomyY
Taxonomy Code367A00000X
TaxonomyAdvanced Practice Midwife
License NumberM002126
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: