Healthcare Provider Details

I. General information

NPI: 1851770937
Provider Name (Legal Business Name): KENNETHYA SMITH-JOHNSON MSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/22/2015
Last Update Date: 03/12/2025
Certification Date: 03/12/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9904 MERLOT LN
NORTH LITTLE ROCK AR
72118-1162
US

IV. Provider business mailing address

4301 W MARKHAM ST # 783
LITTLE ROCK AR
72205-7101
US

V. Phone/Fax

Practice location:
  • Phone: 870-550-3703
  • Fax:
Mailing address:
  • Phone: 502-686-8000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number7600-C
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: