Healthcare Provider Details

I. General information

NPI: 1912227778
Provider Name (Legal Business Name): ROXANNE DENISE HARRIS BS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: ROXANNE DENISE SMITH BS

II. Dates (important events)

Enumeration Date: 06/03/2010
Last Update Date: 06/03/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1729 W 33RD ST B
EDMOND OK
73013-3835
US

IV. Provider business mailing address

1308 NE 43RD ST
OKLAHOMA CITY OK
73111-5853
US

V. Phone/Fax

Practice location:
  • Phone: 405-216-5608
  • Fax: 405-216-5282
Mailing address:
  • Phone: 405-819-9473
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: