Healthcare Provider Details

I. General information

NPI: 1255472049
Provider Name (Legal Business Name): LARA STEPHANIE SMITH M.S.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/12/2007
Last Update Date: 07/31/2026
Certification Date: 07/31/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1621A MIDTOWN PL
MIDWEST CITY OK
73130-6348
US

IV. Provider business mailing address

1621A MIDTOWN PL
MIDWEST CITY OK
73130-6348
US

V. Phone/Fax

Practice location:
  • Phone: 405-736-9300
  • Fax: 405-736-9301
Mailing address:
  • Phone: 405-340-9191
  • Fax: 405-340-9185

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code231H00000X
TaxonomyAudiologist
License Number314
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: