Provider Demographics
NPI:1548927619
Name:SMITHSON, LORETTA (APRN)
Entity type:Individual
Prefix:
First Name:LORETTA
Middle Name:
Last Name:SMITHSON
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:100 N WALNUT AVE
Mailing Address - Street 2:
Mailing Address - City:MANSFIELD
Mailing Address - State:AR
Mailing Address - Zip Code:72944-3522
Mailing Address - Country:US
Mailing Address - Phone:479-928-4404
Mailing Address - Fax:479-928-4414
Practice Address - Street 1:100 N WALNUT AVE
Practice Address - Street 2:
Practice Address - City:MANSFIELD
Practice Address - State:AR
Practice Address - Zip Code:72944-3522
Practice Address - Country:US
Practice Address - Phone:479-928-4404
Practice Address - Fax:479-928-4414
Is Sole Proprietor?:Yes
Enumeration Date:2021-11-23
Last Update Date:2023-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR217886363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Multi-Specialty