Provider Demographics
NPI:1255546974
Name:SMITH, TAMMIE MICHELLE (ACNS-BC)
Entity type:Individual
Prefix:
First Name:TAMMIE
Middle Name:MICHELLE
Last Name:SMITH
Suffix:
Gender:
Credentials:ACNS-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2580 E JOYCE BLVD STE 1
Mailing Address - Street 2:
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:AR
Mailing Address - Zip Code:72703-3924
Mailing Address - Country:US
Mailing Address - Phone:479-305-7201
Mailing Address - Fax:479-787-5613
Practice Address - Street 1:1101 JACKSON ST SW
Practice Address - Street 2:
Practice Address - City:GRAVETTE
Practice Address - State:AR
Practice Address - Zip Code:72736-9121
Practice Address - Country:US
Practice Address - Phone:479-787-5221
Practice Address - Fax:479-787-5613
Is Sole Proprietor?:No
Enumeration Date:2007-05-14
Last Update Date:2025-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARS02236364S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
No364S00000XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse Specialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
5R485OtherBCBS AR
ARP00853320OtherRR MEDICARE
S02236OtherLIC
S02236OtherLIC