Healthcare Provider Details

I. General information

NPI: 1366368789
Provider Name (Legal Business Name): EMILY SMITH
Entity Type: Individual
Gender: Female
Sole Proprietor: N

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

600 SCHOOL ST
JASPER AR
72641-8802
US

IV. Provider business mailing address

11620 AR HWY 16
DEER AR
72628
US

V. Phone/Fax

Practice location:
  • Phone: 870-446-2223
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number223685
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: