Healthcare Provider Details

I. General information

NPI: 1518884220
Provider Name (Legal Business Name): AMANDA JO DEAN SMITH
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/02/2026
Last Update Date: 07/09/2026
Certification Date: 07/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

515 S OSAGE AVE TRLR 9
DEWEY OK
74029-2859
US

IV. Provider business mailing address

515 S OSAGE AVE TRLR 9
DEWEY OK
74029-2859
US

V. Phone/Fax

Practice location:
  • Phone: 918-331-7757
  • Fax:
Mailing address:
  • Phone: 918-331-7757
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code175T00000X
TaxonomyPeer Specialist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: