Provider Demographics
NPI:1962889113
Name:SMITHSON, SHAYNA (CARE COODINATOR)
Entity type:Individual
Prefix:
First Name:SHAYNA
Middle Name:
Last Name:SMITHSON
Suffix:
Gender:F
Credentials:CARE COODINATOR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1134
Mailing Address - Street 2:
Mailing Address - City:MAMMOTH SPRING
Mailing Address - State:AR
Mailing Address - Zip Code:72554-1134
Mailing Address - Country:US
Mailing Address - Phone:870-625-0273
Mailing Address - Fax:870-625-0275
Practice Address - Street 1:1015 LANTON RD
Practice Address - Street 2:
Practice Address - City:WEST PLAINS
Practice Address - State:MO
Practice Address - Zip Code:65775-3854
Practice Address - Country:US
Practice Address - Phone:417-256-2570
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-04-27
Last Update Date:2024-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator