Healthcare Provider Details

I. General information

NPI: 1801331871
Provider Name (Legal Business Name): KAREN GWEN SMITH APRN-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: KAREN GWEN RUSSELL RN

II. Dates (important events)

Enumeration Date: 12/30/2016
Last Update Date: 03/23/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1717 S UTICA AVE STE A
TULSA OK
74104-5346
US

IV. Provider business mailing address

1717 S UTICA AVE STE A
TULSA OK
74104-5346
US

V. Phone/Fax

Practice location:
  • Phone: 918-748-7557
  • Fax: 918-748-7514
Mailing address:
  • Phone: 918-748-7557
  • Fax: 918-748-7514

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number50642
License Number StateOK
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number50642
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: