Provider Demographics
NPI:1235730581
Name:SMITH, CYNTHIA NANETT (APRN)
Entity Type:Individual
Prefix:MISS
First Name:CYNTHIA
Middle Name:NANETT
Last Name:SMITH
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:CYNTHIA
Other - Middle Name:NANETT
Other - Last Name:SMITH
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:APRN
Mailing Address - Street 1:PO BOX 268953
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73126-8953
Mailing Address - Country:US
Mailing Address - Phone:405-310-2715
Mailing Address - Fax:405-463-5732
Practice Address - Street 1:551 SE 4TH ST
Practice Address - Street 2:
Practice Address - City:MOORE
Practice Address - State:OK
Practice Address - Zip Code:73160-6790
Practice Address - Country:US
Practice Address - Phone:405-703-9321
Practice Address - Fax:405-759-7004
Is Sole Proprietor?:Yes
Enumeration Date:2020-11-03
Last Update Date:2023-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK10750506363LF0000X
OK200219363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Single Specialty