Provider Demographics
NPI:1467613562
Name:SMITH, CHANDRA DIONE (APRN, CPNP)
Entity Type:Individual
Prefix:MRS
First Name:CHANDRA
Middle Name:DIONE
Last Name:SMITH
Suffix:
Gender:F
Credentials:APRN, CPNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2701 W 27TH AVE
Mailing Address - Street 2:
Mailing Address - City:PINE BLUFF
Mailing Address - State:AR
Mailing Address - Zip Code:71603-4945
Mailing Address - Country:US
Mailing Address - Phone:501-425-8827
Mailing Address - Fax:
Practice Address - Street 1:7500 DOLLARWAY RD STE 401
Practice Address - Street 2:
Practice Address - City:WHITE HALL
Practice Address - State:AR
Practice Address - Zip Code:71602-3083
Practice Address - Country:US
Practice Address - Phone:903-422-3944
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-06-20
Last Update Date:2022-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARA03124363LP0200X
TXAP130993363LP0200X
SC23850363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR170250758Medicaid
AR5V149Medicare PIN