Healthcare Provider Details

I. General information

NPI: 1699406827
Provider Name (Legal Business Name): MATTHEW S DANIEL APRN-CNP
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/20/2022
Last Update Date: 08/21/2026
Certification Date: 08/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1618 N A ST
FORT SMITH AR
72901-3230
US

IV. Provider business mailing address

1618 N A ST
FORT SMITH AR
72901-3230
US

V. Phone/Fax

Practice location:
  • Phone: 479-774-8168
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number236825
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: