Individual
AMANDA K SMITH
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
6336 BUFFALO RD, WATSON, OK 74963-5145
(817) 298-7460
Mailing address
6336 BUFFALO RD, WATSON, OK 74963-5145
(817) 298-7460
Taxonomy
Speciality
Code
Description
License number
State
175T00000X
Peer Specialist
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
N084156956
DL
OK
Enumeration date
01/28/2022
Last updated
01/28/2022
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