Provider Demographics
NPI:1679660427
Name:SMITH, KELSEY J (MD)
Entity Type:Individual
Prefix:DR
First Name:KELSEY
Middle Name:J
Last Name:SMITH
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1921 W 6TH AVE STE A
Mailing Address - Street 2:
Mailing Address - City:STILLWATER
Mailing Address - State:OK
Mailing Address - Zip Code:74074-4204
Mailing Address - Country:US
Mailing Address - Phone:405-533-2433
Mailing Address - Fax:405-533-2434
Practice Address - Street 1:1921 W 6TH AVE STE A
Practice Address - Street 2:
Practice Address - City:STILLWATER
Practice Address - State:OK
Practice Address - Zip Code:74074-4204
Practice Address - Country:US
Practice Address - Phone:405-533-2433
Practice Address - Fax:405-533-2434
Is Sole Proprietor?:No
Enumeration Date:2006-10-05
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK23786207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK100745000CMedicaid
OK23786OtherMEDICAL LICENSE #
OK23786OtherMEDICAL LICENSE #