Provider Demographics
NPI:1437403235
Name:SMITH, BESSIE
Entity type:Individual
Prefix:
First Name:BESSIE
Middle Name:
Last Name:SMITH
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:BESSIE
Other - Middle Name:
Other - Last Name:FREEMAN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:RN
Mailing Address - Street 1:10855 S WEDINGTON BLACKTOP RD
Mailing Address - Street 2:
Mailing Address - City:LINCOLN
Mailing Address - State:AR
Mailing Address - Zip Code:72744-8532
Mailing Address - Country:US
Mailing Address - Phone:423-794-8794
Mailing Address - Fax:
Practice Address - Street 1:5203 WILLOW CREEK DR STE 2
Practice Address - Street 2:
Practice Address - City:SPRINGDALE
Practice Address - State:AR
Practice Address - Zip Code:72762
Practice Address - Country:US
Practice Address - Phone:479-575-9359
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-10-31
Last Update Date:2019-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARA005959363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatricsGroup - Single Specialty