Healthcare Provider Details

I. General information

NPI: 1518309327
Provider Name (Legal Business Name): KAYSI SMOTHERS MHP, RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/22/2013
Last Update Date: 11/13/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

823 N MAIN ST
HARRISON AR
72601-2914
US

IV. Provider business mailing address

107 E CRANDALL AVE
HARRISON AR
72601-3629
US

V. Phone/Fax

Practice location:
  • Phone: 870-741-2960
  • Fax: 870-741-2965
Mailing address:
  • Phone: 870-741-8484
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberR091028
License Number StateAR
# 3
Primary TaxonomyN
Taxonomy Code163WP0808X
TaxonomyPsychiatric/Mental Health Registered Nurse
License NumberR091028
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: