Provider Demographics
NPI:1518201706
Name:SMIDDY, STACEE DEANNE (APRN-CNP, IBCLC)
Entity Type:Individual
Prefix:MRS
First Name:STACEE
Middle Name:DEANNE
Last Name:SMIDDY
Suffix:
Gender:F
Credentials:APRN-CNP, IBCLC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:250 12TH AVE NE
Mailing Address - Street 2:
Mailing Address - City:NORMAN
Mailing Address - State:OK
Mailing Address - Zip Code:73071-5237
Mailing Address - Country:US
Mailing Address - Phone:405-579-2236
Mailing Address - Fax:
Practice Address - Street 1:250 12TH AVE NE
Practice Address - Street 2:
Practice Address - City:NORMAN
Practice Address - State:OK
Practice Address - Zip Code:73071-5237
Practice Address - Country:US
Practice Address - Phone:405-579-2236
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-11-12
Last Update Date:2014-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK88833163WL0100X, 363LW0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's Health
No163WL0100XNursing Service ProvidersRegistered NurseLactation Consultant