Individual
JOANNA SMITH
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
332 NW 144TH ST, EDMOND, OK 73013-2410
(405) 239-0261
Mailing address
332 NW 144TH ST, EDMOND, OK 73013-2410
Taxonomy
Speciality
Code
Description
License number
State
363LA2200X
Adult Health Nurse Practitioner
AG1217004
OK
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
Primary
2021001219
OK
Other
Enumeration date
01/19/2018
Last updated
10/05/2021
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