Healthcare Provider Details

I. General information

NPI: 1164069530
Provider Name (Legal Business Name): JENNIFER MARIE SMITH-WOOSLEY APRN-CNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: JENNFER MARUE SMITH

II. Dates (important events)

Enumeration Date: 12/04/2019
Last Update Date: 03/31/2020
Certification Date: 03/31/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1145 S UTICA AVE STE 460
TULSA OK
74104-4041
US

IV. Provider business mailing address

1145 S UTICA AVE STE 460
TULSA OK
74104-4041
US

V. Phone/Fax

Practice location:
  • Phone: 918-579-5749
  • Fax: 918-579-5762
Mailing address:
  • Phone: 918-579-5749
  • Fax: 918-579-5762

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberR0097212
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: