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General NPI Number Information
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NPI Number | 1891410536
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Entity Type | Individual
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Provider Name | AMANDA LUANNE SMITH AAS; LPN DEGREE
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Gender | Female
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Dates
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Enumeration Date | 10/05/2022
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Last Update Date | 10/05/2022
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Provider Practice Location Address
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Address Line | 1000 ROLLING HILLS LN
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City | ADA
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State | OK
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Zip | 74820-9415
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Country | US
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Telephone | 158-027-2241
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Fax | 580-436-5824
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Provider Business Mailing Address
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Address Line | 5640 S SAWMILL RD
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City | ATOKA
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State | OK
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Zip | 74525-4960
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Country | US
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Telephone | 158-088-9008
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Fax | 580-436-5824
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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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