Provider Demographics
NPI:1568982817
Name:SMITH, TANYA (BA, IBCLC)
Entity Type:Individual
Prefix:
First Name:TANYA
Middle Name:
Last Name:SMITH
Suffix:
Gender:F
Credentials:BA, IBCLC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6385 WALNUT CV
Mailing Address - Street 2:
Mailing Address - City:BENTON
Mailing Address - State:AR
Mailing Address - Zip Code:72019-1511
Mailing Address - Country:US
Mailing Address - Phone:501-725-1275
Mailing Address - Fax:
Practice Address - Street 1:6385 WALNUT CV
Practice Address - Street 2:
Practice Address - City:BENTON
Practice Address - State:AR
Practice Address - Zip Code:72019-1511
Practice Address - Country:US
Practice Address - Phone:501-725-1275
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-06-27
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
L-108255174N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174N00000XOther Service ProvidersLactation Consultant, Non-RN