Individual
TARA SMITH
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
HIS
Contact information
Practice address
1323 N NAIL PKWY, MOORE, OK 73160-4643
(405) 201-6128
Mailing address
1323 N NAIL PKWY, MOORE, OK 73160-4643
(405) 201-6128
Taxonomy
Speciality
Code
Description
License number
State
374700000X
Technician
Primary
HADF001208
OK
Other
Enumeration date
05/23/2022
Last updated
05/23/2022
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