=====================================================
General NPI Number Information
=====================================================
NPI Number | 1952776569
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | BARBARA LYNN SMITH APRN-CNP
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 12/08/2015
-----------------------------------------------------
Last Update Date | 09/03/2020
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 3 E CLARK BASS BLVD SUITE 2
-----------------------------------------------------
City | MCALESTER
-----------------------------------------------------
State | OK
-----------------------------------------------------
Zip | 74501-4283
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 918-421-6960
-----------------------------------------------------
Fax | 918-421-6094
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1 E CLARK BASS BLVD
-----------------------------------------------------
City | MCALESTER
-----------------------------------------------------
State | OK
-----------------------------------------------------
Zip | 74501-4209
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 918-421-6960
-----------------------------------------------------
Fax | 918-421-6094
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 363L00000X
-----------------------------------------------------
Taxonomy Name | Nurse Practitioner
-----------------------------------------------------
License Number | 102201
-----------------------------------------------------
License Number State | OK
-----------------------------------------------------