Provider Demographics
NPI:1669021580
Name:SMITH, CHRISTOPHER LYNN (APRN-CNP)
Entity Type:Individual
Prefix:
First Name:CHRISTOPHER
Middle Name:LYNN
Last Name:SMITH
Suffix:
Gender:M
Credentials:APRN-CNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:191192 N 4200 RD
Mailing Address - Street 2:
Mailing Address - City:ANTLERS
Mailing Address - State:OK
Mailing Address - Zip Code:74523-3074
Mailing Address - Country:US
Mailing Address - Phone:870-397-3950
Mailing Address - Fax:
Practice Address - Street 1:1020 LAWSON BLVD
Practice Address - Street 2:
Practice Address - City:CLAYTON
Practice Address - State:OK
Practice Address - Zip Code:74536
Practice Address - Country:US
Practice Address - Phone:918-569-4143
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-09-04
Last Update Date:2019-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK111537363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily