Healthcare Provider Details

I. General information

NPI: 1205752607
Provider Name (Legal Business Name): EMILY SMITH RN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/29/2026
Last Update Date: 06/29/2026
Certification Date: 06/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

601 SCHOOL DR
GREEN FOREST AR
72638-3530
US

IV. Provider business mailing address

146 NC 1750
COMPTON AR
72624
US

V. Phone/Fax

Practice location:
  • Phone: 870-438-5205
  • Fax:
Mailing address:
  • Phone: 870-688-2106
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number120281
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: