Healthcare Provider Details

I. General information

NPI: 1881334878
Provider Name (Legal Business Name): LACY BROOKE SMITH ARNP, CPNP-AC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: LACY BROOKE MCCAIG

II. Dates (important events)

Enumeration Date: 03/29/2022
Last Update Date: 11/04/2024
Certification Date: 11/04/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1200 CHILDRENS AVE
OKLAHOMA CITY OK
73104-4637
US

IV. Provider business mailing address

921 S LINFORD DR
STILLWATER OK
74074-5863
US

V. Phone/Fax

Practice location:
  • Phone: 405-417-2225
  • Fax:
Mailing address:
  • Phone: 405-612-6910
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WC0200X
TaxonomyCritical Care Medicine Registered Nurse
License NumberR0109120
License Number StateOK
# 2
Primary TaxonomyY
Taxonomy Code363LA2100X
TaxonomyAcute Care Nurse Practitioner
License NumberAP61620861
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: