Healthcare Provider Details

I. General information

NPI: 1922086149
Provider Name (Legal Business Name): KRISTY M SMOTHERS ARNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/06/2006
Last Update Date: 01/16/2024
Certification Date: 01/16/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2149 ED F DAVIS RD
DURANT OK
74701-3085
US

IV. Provider business mailing address

2149 ED F DAVIS RD
DURANT OK
74701-3085
US

V. Phone/Fax

Practice location:
  • Phone: 580-931-8180
  • Fax: 580-931-8015
Mailing address:
  • Phone: 580-931-8180
  • Fax: 580-931-8015

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberR0062038
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: