Provider Demographics
NPI:1336494061
Name:EDWARDS-SMITH, CAROLYN J (MA)
Entity Type:Individual
Prefix:MRS
First Name:CAROLYN
Middle Name:J
Last Name:EDWARDS-SMITH
Suffix:
Gender:F
Credentials:MA
Other - Prefix:MS
Other - First Name:CAROLYN
Other - Middle Name:J
Other - Last Name:EDWARDS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:12821 STRATFORD DR
Mailing Address - Street 2:#104
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73120-8494
Mailing Address - Country:US
Mailing Address - Phone:405-760-8936
Mailing Address - Fax:
Practice Address - Street 1:2921 NW 156TH ST
Practice Address - Street 2:
Practice Address - City:EDMOND
Practice Address - State:OK
Practice Address - Zip Code:73013-2101
Practice Address - Country:US
Practice Address - Phone:405-760-8936
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-07-18
Last Update Date:2013-01-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator