Provider Demographics
NPI:1558072132
Name:SMITH, CHANCEY JOELLE
Entity Type:Individual
Prefix:
First Name:CHANCEY
Middle Name:JOELLE
Last Name:SMITH
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:674 BROADLEAF RD
Mailing Address - Street 2:
Mailing Address - City:MAMMOTH SPRING
Mailing Address - State:AR
Mailing Address - Zip Code:72554-9322
Mailing Address - Country:US
Mailing Address - Phone:870-847-1057
Mailing Address - Fax:
Practice Address - Street 1:275 MAIN ST
Practice Address - Street 2:
Practice Address - City:MAMMOTH SPRING
Practice Address - State:AR
Practice Address - Zip Code:72554-7484
Practice Address - Country:US
Practice Address - Phone:870-847-1057
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-12-05
Last Update Date:2022-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator