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NPI Code Detail

MEDICARE: JAMES KYLE SMITH

MEDICARE: JAMES KYLE SMITH
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1175T00000XPeer Specialist

General Provider Information

NPI Number : 1073332417
Entity Type Code : Individual
Provider Name (Legal Business Name) : JAMES KYLE SMITH
Provider Business Mailing Address
First Line : 816 LAKEVIEW DR
Second Line :
City : MOORE
State : OK
Zip : 73160-2627
Country : US
Telephone Number : 405-618-8311
Fax Number :
Provider Business Practice Location Address
First Line : 1724 NW 4TH ST
Second Line :
City : OKLAHOMA CITY
State : OK
Zip : 73106-2609
Country : US
Telephone Number : 405-415-8410
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 10/03/2024
Last Update Date : 10/03/2024

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Directions to “ JAMES KYLE SMITH ” Practice Location

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