Provider Demographics
NPI:1043595093
Name:SMITH, ZACHARY ADAM (ARNP)
Entity Type:Individual
Prefix:MR
First Name:ZACHARY
Middle Name:ADAM
Last Name:SMITH
Suffix:
Gender:M
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1445 HEALTH CENTER PKWY
Mailing Address - Street 2:
Mailing Address - City:YUKON
Mailing Address - State:OK
Mailing Address - Zip Code:73099-6492
Mailing Address - Country:US
Mailing Address - Phone:405-577-6701
Mailing Address - Fax:
Practice Address - Street 1:1445 HEALTH CENTER PKWY
Practice Address - Street 2:
Practice Address - City:YUKON
Practice Address - State:OK
Practice Address - Zip Code:73099-6492
Practice Address - Country:US
Practice Address - Phone:405-577-6701
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-10-20
Last Update Date:2011-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK96356363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics