Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LW0102X | Nurse Practitioner - Women's Health | A001096 | AR |
NPI | 1083836886 |
---|---|
Provider Name | Ms. Linda Mckennon Smith |
First Address | Des Moines, IA 50314-2505 |
Second Address | Fayetteville, AR 72703-4582 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 02/05/2007 |
Last Update Date | 02/10/2013 |