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NPI Code Detail

MEDICARE: MRS. GINA RENEA SMITH PA-C

MEDICARE: MRS. GINA RENEA SMITH PA-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
1363AM0700XMedical Physician Assistant1114OK

Other Identifiers

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

General Provider Information

NPI Number : 1942206750
Entity Type Code : Individual
Provider Name (Legal Business Name) : MRS. GINA RENEA SMITH PA-C
Provider Business Mailing Address
First Line : PO BOX 4930
Second Line :
City : TULSA
State : OK
Zip : 74159-0930
Country : US
Telephone Number : 918-747-4975
Fax Number : 918-743-8552
Provider Business Practice Location Address
First Line : 5801 E 41ST ST STE 900
Second Line :
City : TULSA
State : OK
Zip : 74135-5631
Country : US
Telephone Number : 918-747-4975
Fax Number : 918-743-8552
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/27/2005
Last Update Date : 04/22/2024

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Directions to “ MRS. GINA RENEA SMITH PA-C” Practice Location

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