Healthcare Provider Details

I. General information

NPI: 1104236041
Provider Name (Legal Business Name): MRS. KARA SMITH
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/30/2014
Last Update Date: 04/30/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1825 NW 146TH TER
EDMOND OK
73013-2496
US

IV. Provider business mailing address

1825 NW 146TH TER
EDMOND OK
73013-2496
US

V. Phone/Fax

Practice location:
  • Phone: 405-639-1232
  • Fax:
Mailing address:
  • Phone: 405-639-1232
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code102X00000X
TaxonomyPoetry Therapist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: