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General NPI Number Information
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NPI Number | 1912839812
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Entity Type | Individual
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Provider Name | LACARL SMITH
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Gender | Male
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Dates
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Enumeration Date | 06/02/2026
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Last Update Date | 06/02/2026
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Provider Practice Location Address
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Address Line | 1155 FRONT ST STE 1
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City | CONWAY
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State | AR
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Zip | 72032-4373
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Country | US
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Telephone | 501-358-6698
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Fax |
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Provider Business Mailing Address
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Address Line | 1508 S BOSTON PL APT 2
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City | RUSSELLVILLE
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State | AR
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Zip | 72801-7267
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Country | US
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Telephone | 479-747-0412
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225700000X
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Taxonomy Name | Massage Therapist
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License Number | 3823
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License Number State | AR
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