Healthcare Provider Details

I. General information

NPI: 1720274806
Provider Name (Legal Business Name): WILMA JEAN SMITH RN, COHN-S
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: WILMA JEAN MORGAN LPN

II. Dates (important events)

Enumeration Date: 09/21/2007
Last Update Date: 09/21/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3009 WILSON ST REYNOLDS ARMY COMMUNITY HOSPITAL
FORT SILL OK
73503-9042
US

IV. Provider business mailing address

3009 WILSON ST REYNOLDS ARMY COMMUNITY HOSPITAL
FORT SILL OK
73503-9042
US

V. Phone/Fax

Practice location:
  • Phone: 580-458-2134
  • Fax: 580-458-2314
Mailing address:
  • Phone: 580-458-2134
  • Fax: 580-458-2314

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WX0106X
TaxonomyOccupational Health Registered Nurse
License NumberR0046548
License Number StateOK
# 2
Primary TaxonomyN
Taxonomy Code163WX0106X
TaxonomyOccupational Health Registered Nurse
License Number257593
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: