Provider Demographics
NPI:1043517923
Name:SMITH-CRASE, MARY KATHLENE (APN)
Entity type:Individual
Prefix:
First Name:MARY
Middle Name:KATHLENE
Last Name:SMITH-CRASE
Suffix:
Gender:F
Credentials:APN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11501 HURON LN
Mailing Address - Street 2:
Mailing Address - City:LITTLE ROCK
Mailing Address - State:AR
Mailing Address - Zip Code:72211-1846
Mailing Address - Country:US
Mailing Address - Phone:501-904-4762
Mailing Address - Fax:
Practice Address - Street 1:1501 S WALDRON RD STE 208
Practice Address - Street 2:
Practice Address - City:FORT SMITH
Practice Address - State:AR
Practice Address - Zip Code:72903-2565
Practice Address - Country:US
Practice Address - Phone:479-900-0976
Practice Address - Fax:833-954-4044
Is Sole Proprietor?:No
Enumeration Date:2011-02-11
Last Update Date:2025-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARA003489363LP0808X
OKR0067810163WP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No163WP0808XNursing Service ProvidersRegistered NursePsychiatric/Mental Health