Healthcare Provider Details

I. General information

NPI: 1649672031
Provider Name (Legal Business Name): ASHTON NICOLE SMITHERMAN APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/17/2014
Last Update Date: 02/28/2022
Certification Date: 02/28/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

310 BUTTERCUP DR STE A
MOUNTAIN HOME AR
72653-2932
US

IV. Provider business mailing address

301 BUTTERCUP DRIVE STE A
MOUNTAIN HOME AR
72653
US

V. Phone/Fax

Practice location:
  • Phone: 870-508-7080
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberR0096404
License Number StateOK
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number214805
License Number StateAR
# 3
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberR 0096404
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: