Provider Demographics
NPI:1518293083
Name:SMITH, DARLENE (RN, BSN)
Entity Type:Individual
Prefix:MS
First Name:DARLENE
Middle Name:
Last Name:SMITH
Suffix:
Gender:F
Credentials:RN, BSN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:P.O. BOX 34
Mailing Address - Street 2:
Mailing Address - City:POTEAU
Mailing Address - State:OK
Mailing Address - Zip Code:74953-5412
Mailing Address - Country:US
Mailing Address - Phone:918-647-2262
Mailing Address - Fax:918-647-2282
Practice Address - Street 1:3111 N BROADWAY ST
Practice Address - Street 2:SUITE B
Practice Address - City:POTEAU
Practice Address - State:OK
Practice Address - Zip Code:74953-5412
Practice Address - Country:US
Practice Address - Phone:918-647-2262
Practice Address - Fax:918-647-2282
Is Sole Proprietor?:No
Enumeration Date:2009-10-19
Last Update Date:2011-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK0051536163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse