Healthcare Provider Details

I. General information

NPI: 1104717552
Provider Name (Legal Business Name): JASMINE LYNAIR SMITH LPN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/14/2025
Last Update Date: 07/14/2025
Certification Date: 07/14/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3920 WOODLAND HEIGHTS RD
LITTLE ROCK AR
72212-2495
US

IV. Provider business mailing address

3920 WOODLAND HEIGHTS RD
LITTLE ROCK AR
72212-2495
US

V. Phone/Fax

Practice location:
  • Phone: 501-227-3631
  • Fax: 501-227-3601
Mailing address:
  • Phone: 501-940-7775
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code164W00000X
TaxonomyLicensed Practical Nurse
License NumberL054953
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: