Healthcare Provider Details

I. General information

NPI: 1447634555
Provider Name (Legal Business Name): JAMIE L SMITH PTA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: JAMIE L PASLEY

II. Dates (important events)

Enumeration Date: 07/17/2015
Last Update Date: 03/09/2023
Certification Date: 03/09/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3450 W 34TH AVE
PINE BLUFF AR
71603-5508
US

IV. Provider business mailing address

904 RICHARD ALAN RD
WHITE HALL AR
71602-8881
US

V. Phone/Fax

Practice location:
  • Phone: 870-534-7392
  • Fax: 870-534-7297
Mailing address:
  • Phone: 870-941-8986
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License Number3981
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: