Healthcare Provider Details

I. General information

NPI: 1548449937
Provider Name (Legal Business Name): EDWINNA SMITH ARNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/01/2007
Last Update Date: 10/25/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1415 WATTS ST
SAYRE OK
73662-1310
US

IV. Provider business mailing address

1901 W 3RD ST STE C
ELK CITY OK
73644-4340
US

V. Phone/Fax

Practice location:
  • Phone: 580-928-2044
  • Fax:
Mailing address:
  • Phone: 580-339-8001
  • Fax: 580-339-8031

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberR0075474
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: