Individual
JESSE SMITH
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
SPECIAL CARE PARA
Contact information
Practice address
225 N WATER AVE, TAHLEQUAH, OK 74464-2825
(918) 458-4100
Mailing address
225 N WATER AVE, TAHLEQUAH, OK 74464-2825
(918) 458-4100
Taxonomy
Speciality
Code
Description
License number
State
376K00000X
Nurse's Aide
Primary
—
—
Other
Enumeration date
08/09/2016
Last updated
08/09/2016
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