Provider Demographics
NPI:1043593270
Name:SMITH, RHONDA YVONNE (PRSS)
Entity Type:Individual
Prefix:MS
First Name:RHONDA
Middle Name:YVONNE
Last Name:SMITH
Suffix:
Gender:F
Credentials:PRSS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:822 PINEBROOK DR
Mailing Address - Street 2:
Mailing Address - City:GUTHRIE
Mailing Address - State:OK
Mailing Address - Zip Code:73044-4518
Mailing Address - Country:US
Mailing Address - Phone:405-293-9141
Mailing Address - Fax:405-282-0083
Practice Address - Street 1:1916 E PERKINS AVE
Practice Address - Street 2:
Practice Address - City:GUTHRIE
Practice Address - State:OK
Practice Address - Zip Code:73044-5804
Practice Address - Country:US
Practice Address - Phone:405-282-8232
Practice Address - Fax:405-282-0083
Is Sole Proprietor?:Yes
Enumeration Date:2011-09-23
Last Update Date:2011-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK906041171M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator