MEDICARE: ALYSSA R SMITH APRN-PMHNP-BC

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	363LP0808X	Psychiatric/Mental Health Nurse Practitioner	214495	OK

General Provider Information

NPI Number	:	1659053718
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ALYSSA R SMITH APRN-PMHNP-BC

Provider Business Mailing Address
First Line	:	1900 NW EXPRESSWAY STE 900
Second Line	:
City	:	OKLAHOMA CITY
State	:	OK
Zip	:	73118-1821
Country	:	US
Telephone Number	:	405-420-6646
Fax Number	:

Provider Business Practice Location Address
First Line	:	1900 NW EXPRESSWAY STE 900
Second Line	:
City	:	OKLAHOMA CITY
State	:	OK
Zip	:	73118-1821
Country	:	US
Telephone Number	:	405-420-6646
Fax Number	:	580-215-5755

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

Provider Enumeration Date	:	08/07/2023
Last Update Date	:	08/07/2023

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