Provider Demographics
NPI:1578731626
Name:SMITH, JOVONNE K (PA)
Entity Type:Individual
Prefix:
First Name:JOVONNE
Middle Name:K
Last Name:SMITH
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Gender:F
Credentials:PA
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Mailing Address - Street 1:3433 NW 56TH ST
Mailing Address - Street 2:STE 400
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73112-4455
Mailing Address - Country:US
Mailing Address - Phone:405-946-9831
Mailing Address - Fax:405-947-0408
Practice Address - Street 1:3433 NW 56TH ST
Practice Address - Street 2:STE 800
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73112-4455
Practice Address - Country:US
Practice Address - Phone:405-946-9831
Practice Address - Fax:405-947-0408
Is Sole Proprietor?:No
Enumeration Date:2008-02-12
Last Update Date:2008-02-12
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
OK1731363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant