MEDICARE: SHELLY R SMITH APRN, FNP-C,CRNFA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	163WR0006X	Registered Nurse First Assistant	607045	TX
2	363L00000X	Nurse Practitioner	225130	OK
3	363L00000X	Nurse Practitioner	AP136443	TX

General Provider Information

NPI Number	:	1730263500
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SHELLY R SMITH APRN, FNP-C,CRNFA

Provider Business Mailing Address
First Line	:	PO BOX 95469
Second Line	:
City	:	GRAPEVINE
State	:	TX
Zip	:	76099-9700
Country	:	US
Telephone Number	:	405-445-1210
Fax Number	:	405-445-3310

Provider Business Practice Location Address
First Line	:	1327 OKLAHOMA AVE
Second Line	:
City	:	WOODWARD
State	:	OK
Zip	:	73801-4454
Country	:	US
Telephone Number	:	580-254-2377
Fax Number	:	580-254-2388

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/25/2006
Last Update Date	:	10/09/2025

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