Provider Demographics
NPI:1750585063
Name:SMITH, CAROLYN R (APN)
Entity type:Individual
Prefix:MRS
First Name:CAROLYN
Middle Name:R
Last Name:SMITH
Suffix:
Gender:F
Credentials:APN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1060
Mailing Address - Street 2:
Mailing Address - City:MARSHALL
Mailing Address - State:AR
Mailing Address - Zip Code:72650-1060
Mailing Address - Country:US
Mailing Address - Phone:870-448-5101
Mailing Address - Fax:870-448-3767
Practice Address - Street 1:326 SOUTH SIDE ROAD
Practice Address - Street 2:
Practice Address - City:BEE BRANCH
Practice Address - State:AR
Practice Address - Zip Code:72013-9137
Practice Address - Country:US
Practice Address - Phone:501-654-2006
Practice Address - Fax:501-654-2016
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-12
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARAO1838363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR166812758Medicaid
ARA01838OtherSTATE LICENSE
ARMM1232913OtherDEA
ARA01838OtherSTATE LICENSE