Healthcare Provider Details

I. General information

NPI: 1174961486
Provider Name (Legal Business Name): CHELSEA ELIZABETH SMITH D.O.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/08/2013
Last Update Date: 11/19/2022
Certification Date: 11/19/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1373 E BOONE ST STE 2300
TAHLEQUAH OK
74464-3365
US

IV. Provider business mailing address

4112 NW 152ND TER
EDMOND OK
73013-9248
US

V. Phone/Fax

Practice location:
  • Phone: 918-207-0025
  • Fax: 918-207-0226
Mailing address:
  • Phone: 54-461-5874
  • Fax: 405-446-2587

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number7084
License Number StateOK

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: