Provider Demographics
NPI:1023702537
Name:SMITH, JAMIE PITCOCK (CRNA)
Entity type:Individual
Prefix:DR
First Name:JAMIE
Middle Name:PITCOCK
Last Name:SMITH
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:DR
Other - First Name:JAMIE
Other - Middle Name:ALLISON
Other - Last Name:PITCOCK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CRNA
Mailing Address - Street 1:105 KACY DR
Mailing Address - Street 2:
Mailing Address - City:SEARCY
Mailing Address - State:AR
Mailing Address - Zip Code:72143-9024
Mailing Address - Country:US
Mailing Address - Phone:901-240-0423
Mailing Address - Fax:
Practice Address - Street 1:3214 E RACE AVE
Practice Address - Street 2:
Practice Address - City:SEARCY
Practice Address - State:AR
Practice Address - Zip Code:72143-4810
Practice Address - Country:US
Practice Address - Phone:501-268-6121
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-06-07
Last Update Date:2024-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN215109163W00000X
TN0000034748367500000X
AR226456367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
No163W00000XNursing Service ProvidersRegistered Nurse