MEDICARE: EDWINNA SMITH ARNP

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	363LF0000X	Family Nurse Practitioner	R0075474	OK

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1548449937
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	EDWINNA SMITH ARNP

Provider Business Mailing Address
First Line	:	1901 W 3RD ST STE C
Second Line	:
City	:	ELK CITY
State	:	OK
Zip	:	73644-4340
Country	:	US
Telephone Number	:	580-339-8001
Fax Number	:	580-339-8031

Provider Business Practice Location Address
First Line	:	1415 WATTS ST
Second Line	:
City	:	SAYRE
State	:	OK
Zip	:	73662-1310
Country	:	US
Telephone Number	:	580-928-2044
Fax Number	:

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

Provider Enumeration Date	:	11/01/2007
Last Update Date	:	10/25/2017

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