Individual
KIMBERLY A SMALLWOOD
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
APRN
Contact information
Practice address
2617 S ELM PL, BROKEN ARROW, OK 74012
(918) 455-4541
(918) 455-0414
Mailing address
2617 S ELM PL, BROKEN ARROW, OK 74012-7850
(918) 455-4541
(918) 455-0414
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
Primary
91402
OK
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
200739390A
—
OK
Enumeration date
10/17/2017
Last updated
08/07/2018
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