Healthcare Provider Details

I. General information

NPI: 1639447675
Provider Name (Legal Business Name): MS. LINDA SMITH
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/06/2011
Last Update Date: 12/06/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3302 E MOORE AVE
SEARCY AR
72143-4886
US

IV. Provider business mailing address

PO BOX 475
COTTON PLANT AR
72036-0475
US

V. Phone/Fax

Practice location:
  • Phone: 501-268-4181
  • Fax:
Mailing address:
  • Phone: 870-347-6295
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: