Healthcare Provider Details

I. General information

NPI: 1255546974
Provider Name (Legal Business Name): TAMMIE MICHELLE SMITH ACNS-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/14/2007
Last Update Date: 09/11/2025
Certification Date: 02/04/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1101 JACKSON ST SW
GRAVETTE AR
72736-9121
US

IV. Provider business mailing address

2580 E JOYCE BLVD STE 1
FAYETTEVILLE AR
72703-3924
US

V. Phone/Fax

Practice location:
  • Phone: 479-787-5221
  • Fax: 479-787-5613
Mailing address:
  • Phone: 479-305-7201
  • Fax: 479-787-5613

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code364S00000X
TaxonomyClinical Nurse Specialist
License NumberS02236
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: