Healthcare Provider Details

I. General information

NPI: 1972099059
Provider Name (Legal Business Name): BRENAN DAVIS SMITH DNP, APRN, FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/02/2018
Last Update Date: 03/08/2024
Certification Date: 03/08/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

318 S RHODES ST
WEST MEMPHIS AR
72301-4215
US

IV. Provider business mailing address

PO BOX 497
AUGUSTA AR
72006-0497
US

V. Phone/Fax

Practice location:
  • Phone: 870-394-3023
  • Fax: 870-551-4394
Mailing address:
  • Phone: 870-347-2534
  • Fax: 870-347-2023

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberA005857
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: