Provider Information for 1134410467
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Mrs. DALISHA LAREECE SMITH MHPP
Sex: Female
NPI: 1134410467
Last Updated: 2023-12-18
Certification Date: 2023-12-18
Certification Date: 2023-12-18
Details
| Name | Value | ||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| NPI | 1134410467 | ||||||||||||||||
| Enumeration Date | 2011-04-20 | ||||||||||||||||
| NPI Type | NPI-1 Individual | ||||||||||||||||
| Sole Proprietor | NO | ||||||||||||||||
| Status | Active | ||||||||||||||||
| Mailing Address | PO BOX 11064 FAYETTEVILLE, AR 72703-1001 United States Phone: 870-520-5014 | Fax:479-323-3912 | ||||||||||||||||
| Primary Practice Address | 1792 FALLS BLVD N STE 5 WYNNE, AR 72396-4093 United States Phone: 870-208-9333 | Fax:479-323-3912 | ||||||||||||||||
| Secondary Practice Address(es) | 1217 W PARKER RD STE D | ||||||||||||||||
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