Provider Demographics
NPI:1770303745
Name:SMITH, NANCY E (MED, BCBA)
Entity type:Individual
Prefix:
First Name:NANCY
Middle Name:E
Last Name:SMITH
Suffix:
Gender:F
Credentials:MED, BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:207 PLAZA BLVD
Mailing Address - Street 2:
Mailing Address - City:CABOT
Mailing Address - State:AR
Mailing Address - Zip Code:72023-3749
Mailing Address - Country:US
Mailing Address - Phone:501-628-5580
Mailing Address - Fax:501-628-5583
Practice Address - Street 1:207 PLAZA BLVD
Practice Address - Street 2:
Practice Address - City:CABOT
Practice Address - State:AR
Practice Address - Zip Code:72023-3749
Practice Address - Country:US
Practice Address - Phone:501-628-5580
Practice Address - Fax:501-628-5583
Is Sole Proprietor?:Yes
Enumeration Date:2024-10-15
Last Update Date:2024-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst