=====================================================
General NPI Number Information
=====================================================
NPI Number | 1548927619
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | LORETTA SMITHSON APRN
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 11/23/2021
-----------------------------------------------------
Last Update Date | 05/05/2023
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 100 N WALNUT AVE
-----------------------------------------------------
City | MANSFIELD
-----------------------------------------------------
State | AR
-----------------------------------------------------
Zip | 72944-3522
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 479-928-4404
-----------------------------------------------------
Fax | 479-928-4414
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 100 N WALNUT AVE
-----------------------------------------------------
City | MANSFIELD
-----------------------------------------------------
State | AR
-----------------------------------------------------
Zip | 72944-3522
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 479-928-4404
-----------------------------------------------------
Fax | 479-928-4414
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 363LF0000X
-----------------------------------------------------
Taxonomy Name | Family Nurse Practitioner
-----------------------------------------------------
License Number | 217886
-----------------------------------------------------
License Number State | AR
-----------------------------------------------------