Provider Demographics
NPI:1013563493
Name:SMITH, STARLA LYNNETTE (NP)
Entity Type:Individual
Prefix:
First Name:STARLA
Middle Name:LYNNETTE
Last Name:SMITH
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:308 HIGHWAY 62 W
Mailing Address - Street 2:
Mailing Address - City:ASH FLAT
Mailing Address - State:AR
Mailing Address - Zip Code:72513-9415
Mailing Address - Country:US
Mailing Address - Phone:417-934-2251
Mailing Address - Fax:
Practice Address - Street 1:308 HIGHWAY 62 W
Practice Address - Street 2:
Practice Address - City:ASH FLAT
Practice Address - State:AR
Practice Address - Zip Code:72513-9415
Practice Address - Country:US
Practice Address - Phone:870-994-2202
Practice Address - Fax:870-994-2328
Is Sole Proprietor?:No
Enumeration Date:2019-08-12
Last Update Date:2020-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2019033524363LF0000X
ARA006141363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily