Healthcare Provider Details

I. General information

NPI: 1992108773
Provider Name (Legal Business Name): JAYMI SMITH APRN-CNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/07/2014
Last Update Date: 09/16/2024
Certification Date: 09/16/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3201 W GORE BLVD STE 304
LAWTON OK
73505-6350
US

IV. Provider business mailing address

PO BOX 785
LAWTON OK
73502-0785
US

V. Phone/Fax

Practice location:
  • Phone: 580-353-6760
  • Fax: 580-248-3760
Mailing address:
  • Phone: 580-357-9984
  • Fax: 580-357-3277

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number1398
License Number StateOK
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number112805
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: