MEDICARE: MRS. ANGELA ROSE SMITH NP-C

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LF0000X	Family Nurse Practitioner	216273	AR

General Provider Information

NPI Number	:	1396313615
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. ANGELA ROSE SMITH NP-C

Provider Business Mailing Address
First Line	:	5901 ROCK SPRINGS RD
Second Line	:
City	:	HARRISON
State	:	AR
Zip	:	72601-9773
Country	:	US
Telephone Number	:	870-577-3896
Fax Number	:

Provider Business Practice Location Address
First Line	:	5901 ROCK SPRINGS RD
Second Line	:
City	:	HARRISON
State	:	AR
Zip	:	72601-9773
Country	:	US
Telephone Number	:	870-577-3896
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/14/2021
Last Update Date	:	06/17/2021

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