Provider Demographics
NPI:1790114304
Name:SMITH, ANGELA D (MHPP, MS)
Entity Type:Individual
Prefix:
First Name:ANGELA
Middle Name:D
Last Name:SMITH
Suffix:
Gender:F
Credentials:MHPP, MS
Other - Prefix:
Other - First Name:ANGIE
Other - Middle Name:
Other - Last Name:SMITH
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:140 MARIWOOD LN
Mailing Address - Street 2:
Mailing Address - City:DOVER
Mailing Address - State:AR
Mailing Address - Zip Code:72837-8187
Mailing Address - Country:US
Mailing Address - Phone:479-970-9421
Mailing Address - Fax:
Practice Address - Street 1:1021 E POPLAR ST
Practice Address - Street 2:
Practice Address - City:CLARKSVILLE
Practice Address - State:AR
Practice Address - Zip Code:72830-4428
Practice Address - Country:US
Practice Address - Phone:479-970-3694
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-11-04
Last Update Date:2013-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator