Healthcare Provider Details

I. General information

NPI: 1093476012
Provider Name (Legal Business Name): KAYLA SMOOT APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/02/2022
Last Update Date: 03/11/2022
Certification Date: 03/11/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4705 S 129TH EAST AVE
TULSA OK
74134-7005
US

IV. Provider business mailing address

4715 E 23RD ST
TULSA OK
74114-3640
US

V. Phone/Fax

Practice location:
  • Phone: 918-994-3471
  • Fax:
Mailing address:
  • Phone: 918-520-9575
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WC0200X
TaxonomyCritical Care Medicine Registered Nurse
License NumberR0108424
License Number StateOK
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number206752
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: