Individual
SHELLY SMITH
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
401 N OKLAHOMA AVE, MANGUM, OK 73554-3011
(580) 782-5912
Mailing address
401 N OKLAHOMA AVE, MANGUM, OK 73554-3011
Taxonomy
Speciality
Code
Description
License number
State
3747P1801X
Personal Care Attendant
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
736021103
MANGUM PUBLIC SCHOOLS
OK
Enumeration date
12/05/2018
Last updated
12/05/2018
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