Individual
TYLER SMITH
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
NP
Contact information
Practice address
11204 S CLEVELAND ST, JENKS, OK 74037-6202
(918) 859-4691
Mailing address
11204 S CLEVELAND ST, JENKS, OK 74037-6202
(918) 859-4691
Taxonomy
Speciality
Code
Description
License number
State
363LA2100X
Acute Care Nurse Practitioner
105650
OK
363LF0000X
Family Nurse Practitioner
Primary
105650
OK
Other
Enumeration date
04/28/2016
Last updated
04/28/2016
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