Provider Demographics
NPI:1639061989
Name:SMITH, HOLLY RICKELL
Entity type:Individual
Prefix:
First Name:HOLLY
Middle Name:RICKELL
Last Name:SMITH
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:726 N SLEMONS ST APT 7
Mailing Address - Street 2:
Mailing Address - City:MONTICELLO
Mailing Address - State:AR
Mailing Address - Zip Code:71655-4148
Mailing Address - Country:US
Mailing Address - Phone:870-344-0633
Mailing Address - Fax:
Practice Address - Street 1:1303 HIGHWAY 65 N
Practice Address - Street 2:
Practice Address - City:MC GEHEE
Practice Address - State:AR
Practice Address - Zip Code:71654-9431
Practice Address - Country:US
Practice Address - Phone:870-367-1548
Practice Address - Fax:870-367-1383
Is Sole Proprietor?:No
Enumeration Date:2025-07-18
Last Update Date:2025-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR5057225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant