MEDICARE: KAREN CHRISTINE SMITH FNP-C

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
1	363L00000X	Nurse Practitioner	R0071822	OK

General Provider Information

NPI Number	:	1255831657
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KAREN CHRISTINE SMITH FNP-C

Provider Business Mailing Address
First Line	:	5600 SE 67TH ST STE 200
Second Line	:
City	:	OKLAHOMA CITY
State	:	OK
Zip	:	73135-1719
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	5600 SE 67TH ST STE 200
Second Line	:
City	:	OKLAHOMA CITY
State	:	OK
Zip	:	73135-1719
Country	:	US
Telephone Number	:	405-455-4058
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/13/2018
Last Update Date	:	09/01/2024

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