Healthcare Provider Details

I. General information

NPI: 1124931787
Provider Name (Legal Business Name): PATRICIA SMITH RN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/24/2026
Last Update Date: 09/24/2026
Certification Date: 09/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

134 EMERALD LAKE DR
SEARCY AR
72143-3055
US

IV. Provider business mailing address

134 EMERALD LAKE DR
SEARCY AR
72143-3055
US

V. Phone/Fax

Practice location:
  • Phone: 804-337-9035
  • Fax:
Mailing address:
  • Phone: 804-337-9035
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WC0200X
TaxonomyCritical Care Medicine Registered Nurse
License NumberR078914
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: