Healthcare Provider Details

I. General information

NPI: 1366897142
Provider Name (Legal Business Name): SIERRA DAWN ELSEY DNP NP-C BSN IBCLC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: DR. SIERRA DAWN SMITH

II. Dates (important events)

Enumeration Date: 04/28/2016
Last Update Date: 10/29/2021
Certification Date: 10/11/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1631 TEXAS ST
WOODWARD OK
73801-3041
US

IV. Provider business mailing address

PO BOX 397
MOORELAND OK
73852-0397
US

V. Phone/Fax

Practice location:
  • Phone: 580-334-3711
  • Fax:
Mailing address:
  • Phone: 580-334-3711
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberR0106919
License Number StateOK
# 2
Primary TaxonomyN
Taxonomy Code163WL0100X
TaxonomyLactation Consultant (Registered Nurse)
License NumberL-67387
License Number StateOK
# 3
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberF10210870
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: