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General NPI Number Information
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NPI Number | 1003619008
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Entity Type | Individual
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Provider Name | TIFFANY RENEE SMITH
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Gender | Female
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Dates
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Enumeration Date | 03/27/2025
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Last Update Date | 03/27/2025
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Provider Practice Location Address
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Address Line | 10603 SE 15TH ST
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City | MIDWEST CITY
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State | OK
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Zip | 73130-6015
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Country | US
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Telephone | 405-549-8606
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Fax |
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Provider Business Mailing Address
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Address Line | 1428 SW 43RD ST
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City | OKLAHOMA CITY
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State | OK
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Zip | 73119-4034
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Country | US
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Telephone | 405-305-8019
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 171M00000X
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Taxonomy Name | Case Manager/Care Coordinator
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License Number |
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License Number State |
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