Provider Demographics
NPI:1285000661
Name:SMITH, BRENDA
Entity Type:Individual
Prefix:
First Name:BRENDA
Middle Name:
Last Name:SMITH
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:308 WEST SMISER
Mailing Address - Street 2:
Mailing Address - City:CALERA
Mailing Address - State:OK
Mailing Address - Zip Code:74730-0308
Mailing Address - Country:US
Mailing Address - Phone:580-434-5700
Mailing Address - Fax:580-434-5800
Practice Address - Street 1:308 WEST SMISER
Practice Address - Street 2:
Practice Address - City:CALERA
Practice Address - State:OK
Practice Address - Zip Code:74730
Practice Address - Country:US
Practice Address - Phone:580-434-5700
Practice Address - Fax:580-434-5800
Is Sole Proprietor?:No
Enumeration Date:2015-08-19
Last Update Date:2015-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174H00000XOther Service ProvidersHealth Educator