Provider Demographics
NPI:1316537319
Name:SMITH, ELIZA MAE (APRN-CNP-FNP-BC)
Entity Type:Individual
Prefix:
First Name:ELIZA
Middle Name:MAE
Last Name:SMITH
Suffix:
Gender:F
Credentials:APRN-CNP-FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:79381 S 4697 RD
Mailing Address - Street 2:
Mailing Address - City:STILWELL
Mailing Address - State:OK
Mailing Address - Zip Code:74960-3095
Mailing Address - Country:US
Mailing Address - Phone:918-797-7284
Mailing Address - Fax:
Practice Address - Street 1:5700 PHOENIX AVE
Practice Address - Street 2:
Practice Address - City:FORT SMITH
Practice Address - State:AR
Practice Address - Zip Code:72903-6073
Practice Address - Country:US
Practice Address - Phone:479-441-2600
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-01-22
Last Update Date:2023-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OKR0082263363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily