Individual
SHARON L SMITH
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
APRN
Contact information
Practice address
1150 E LANSING ST, BROKEN ARROW, OK 74012-2429
(918) 921-7661
(918) 921-7662
Mailing address
1150 E LANSING ST, SUITE 201, BROKEN ARROW, OK 74012-2429
(918) 921-7661
(918) 921-7662
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
R103794
OK
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
200436210A
—
OK
01
—
332898YLM3
MEDICARE PTAN
OK
01
—
332898YXXJ
MEDICARE PTAN
OK
Enumeration date
02/21/2012
Last updated
03/26/2019
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