Healthcare Provider Details

I. General information

NPI: 1659377752
Provider Name (Legal Business Name): KATHERYN M SMITH APRN, PMHNP, FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/23/2005
Last Update Date: 08/07/2025
Certification Date: 08/07/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

105C W WALL ST
HARRISONVILLE MO
64701-2355
US

IV. Provider business mailing address

PO BOX 301
PIGGOTT AR
72454-0301
US

V. Phone/Fax

Practice location:
  • Phone: 870-970-3180
  • Fax: 870-343-6262
Mailing address:
  • Phone: 870-970-3180
  • Fax: 870-343-6262

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number129159
License Number StateMO
# 2
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number2022035162
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: