Provider Demographics
NPI:1518309327
Name:SMOTHERS, KAYSI (MHP, RN)
Entity Type:Individual
Prefix:
First Name:KAYSI
Middle Name:
Last Name:SMOTHERS
Suffix:
Gender:F
Credentials:MHP, RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:107 E CRANDALL AVE
Mailing Address - Street 2:
Mailing Address - City:HARRISON
Mailing Address - State:AR
Mailing Address - Zip Code:72601-3629
Mailing Address - Country:US
Mailing Address - Phone:870-741-8484
Mailing Address - Fax:
Practice Address - Street 1:823 N MAIN ST
Practice Address - Street 2:
Practice Address - City:HARRISON
Practice Address - State:AR
Practice Address - Zip Code:72601-2914
Practice Address - Country:US
Practice Address - Phone:870-741-2960
Practice Address - Fax:870-741-2965
Is Sole Proprietor?:No
Enumeration Date:2013-07-22
Last Update Date:2014-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
171M00000X
ARR091028101YM0800X, 163WP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No171M00000XOther Service ProvidersCase Manager/Care Coordinator
No163WP0808XNursing Service ProvidersRegistered NursePsychiatric/Mental Health