Individual
MRS. REBEL DAWN SMITH
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
ARNP
Contact information
Practice address
301 J T STITES BLVD, SALLISAW, OK 74955-9302
(918) 775-9150
Mailing address
301 S J T STITES ST, SALLISAW, OK 74955-9302
(918) 775-9150
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
R0072185
OK
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1772185
—
OK
01
—
8EB426
MEDICARE ID
OK
Enumeration date
08/12/2005
Last updated
06/24/2019
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