Gladys Kabamba Smith, FAMILY NURSE PRACTIT

Primary specialty

Family Nurse PractitionerTaxonomy code 363LF0000X

License

F08210825 Issued in AR

Practice address

104 E Main St
Anderson, MO 64831-4103

Phone

(417) 845-6984

Fax

(417) 845-6976

NPI assigned

Sep 27, 2022

Last updated

Aug 16, 2023By the provider in NPPES

Sex

Female

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in MO, AR2 enrollments

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: No

Green means eligible to order or refer.

Enrollment records 2

Specialty

Nurse Practitioner

Education

Other, 2020

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Sgoh Acquisition IncGroup PAC ID 5092616276, 95 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Ozarks Community Hospital of Gravette Hospital, Gravette, AR, CCN 041331

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Sgoh Acquisition Inc

  • Clinic/Center
  • Springfield, MO
  • NPI 1114924768
  Medicare reassignment Care Compare group NPD
• Pinnacle Health Partners PLLC

  dba Diversity Family Health

  • Primary Care Clinic/Center
  • Little Rock, AR
  • NPI 1891357455
  Medicare reassignment
• Sgoh Acquisition Inc

  dba Och Decatur Clinic

  • Rural Health Clinic/Center
  • Decatur, AR
  • NPI 1699513507
  NPD
• Sgoh Acquisition Inc

  dba Ozarks Community Hospital of Gravette

  • Critical Access Hospital
  • Gravette, AR
  • NPI 1568643005
  NPD (past)

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

• Sgoh Acquisition Inc

  dba Ozarks Community Hospital of Gravette

  • Critical Access Hospital
  • Gravette, AR
  • NPI 1568643005
  Care Compare affiliation

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1664236800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1692144000000",
    "number": "1154045821",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1501 LANCELOT ST",
            "city": "LOWELL",
            "state": "AR",
            "postal_code": "727459598",
            "telephone_number": "479-166-1553"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "104 E MAIN ST",
            "city": "ANDERSON",
            "state": "MO",
            "postal_code": "648314103",
            "telephone_number": "417-845-6984",
            "fax_number": "417-845-6976"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1501 Lancelot St",
            "address_purpose": "LOCATION",
            "city": "Lowell",
            "state": "AR",
            "postal_code": "727459598",
            "country_code": "US",
            "telephone_number": "479-466-1553",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "SMITH",
        "first_name": "GLADYS",
        "middle_name": "KABAMBA",
        "name_prefix": "Mrs.",
        "credential": "FAMILY NURSE PRACTIT",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2022-09-27",
        "last_updated": "2023-08-16",
        "certification_date": "2023-08-16",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "AR",
            "license": "F08210825",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Play Skills Pediatrics
• Joel Adam Poland
• Erica Price, LPC
• Charlie Richey
• Sgoh Acquisition, Inc.
• Kathryn Smith, PHARMD
• Shelby Alayne Spangler
• Abby Sutherland
• Crystal Talbert, RDH
• Dawn L Talbert, FNP

• Family Nurse Practitioner in Anderson, MO
• Providers in Anderson, MO by specialty
• Family Nurse Practitioner in Missouri

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 16, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.