Healthcare Provider Details

I. General information

NPI: 1144682113
Provider Name (Legal Business Name): JESSICA MARIE SMITH MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: JESSICA MARIE JOHNSON

II. Dates (important events)

Enumeration Date: 03/28/2016
Last Update Date: 10/18/2023
Certification Date: 10/18/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1629 AIRPORT RD STE B
HOT SPRINGS AR
71913-8069
US

IV. Provider business mailing address

1661 AIRPORT RD STE D
HOT SPRINGS AR
71913-8184
US

V. Phone/Fax

Practice location:
  • Phone: 501-767-0075
  • Fax: 501-767-4455
Mailing address:
  • Phone: 501-625-7500
  • Fax: 501-625-7777

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberE-12239
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: