Provider Demographics
NPI:1659373223
Name:SMITH, REBEL DAWN (ARNP)
Entity Type:Individual
Prefix:MRS
First Name:REBEL
Middle Name:DAWN
Last Name:SMITH
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:MRS
Other - First Name:REBEL
Other - Middle Name:DAWN
Other - Last Name:BURMASTER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:ARNP
Mailing Address - Street 1:301 S J T STITES ST
Mailing Address - Street 2:
Mailing Address - City:SALLISAW
Mailing Address - State:OK
Mailing Address - Zip Code:74955-9302
Mailing Address - Country:US
Mailing Address - Phone:918-775-9150
Mailing Address - Fax:
Practice Address - Street 1:301 J T STITES BLVD
Practice Address - Street 2:
Practice Address - City:SALLISAW
Practice Address - State:OK
Practice Address - Zip Code:74955-9302
Practice Address - Country:US
Practice Address - Phone:918-775-9150
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-08-12
Last Update Date:2019-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OKR0072185363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK8EB426OtherMEDICARE ID
OK1772185Medicaid
P99597Medicare UPIN