MEDICARE: RACHEAL 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
1	164X00000X	Licensed Vocational Nurse	66730	OK

General Provider Information

NPI Number	:	1932921871
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	RACHEAL SMITH

Provider Business Mailing Address
First Line	:	49210 MACARTHUR ST
Second Line	:
City	:	SHAWNEE
State	:	OK
Zip	:	74804-1535
Country	:	US
Telephone Number	:	405-929-9080
Fax Number	:

Provider Business Practice Location Address
First Line	:	4901 S PENNSYLVANIA AVE
Second Line	:
City	:	OKLAHOMA CITY
State	:	OK
Zip	:	73119-4930
Country	:	US
Telephone Number	:	405-605-4005
Fax Number	:

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

Provider Enumeration Date	:	10/31/2024
Last Update Date	:	10/31/2024

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Directions to “ RACHEAL SMITH ” Practice Location

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