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General NPI Number Information
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NPI Number | 1932921871
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Entity Type | Individual
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Provider Name | RACHEAL SMITH
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Gender | Female
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Dates
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Enumeration Date | 10/31/2024
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Last Update Date | 10/31/2024
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Provider Practice Location Address
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Address Line | 4901 S PENNSYLVANIA AVE
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City | OKLAHOMA CITY
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State | OK
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Zip | 73119-4930
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Country | US
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Telephone | 405-605-4005
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Fax |
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Provider Business Mailing Address
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Address Line | 49210 MACARTHUR ST
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City | SHAWNEE
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State | OK
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Zip | 74804-1535
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Country | US
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Telephone | 405-929-9080
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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 | 164X00000X
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Taxonomy Name | Licensed Vocational Nurse
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License Number | 66730
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License Number State | OK
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