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NPI Code Detail

MEDICARE: MRS. REBEL DAWN SMITH ARNP

MEDICARE: MRS. REBEL DAWN 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
1363LF0000XFamily Nurse PractitionerR0072185OK

Medicare Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
18EB426OTHEROKMEDICARE ID

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
2MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1659373223
Entity Type Code : Individual
Provider Name (Legal Business Name) : MRS. REBEL DAWN SMITH ARNP
Provider Business Mailing Address
First Line : 301 S J T STITES ST
Second Line :
City : SALLISAW
State : OK
Zip : 74955-9302
Country : US
Telephone Number : 918-775-9150
Fax Number :
Provider Business Practice Location Address
First Line : 301 J T STITES BLVD
Second Line :
City : SALLISAW
State : OK
Zip : 74955-9302
Country : US
Telephone Number : 918-775-9150
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/12/2005
Last Update Date : 06/24/2019

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