Provider Demographics
NPI:1790120483
Name:SMART, KEENAN (MD)
Entity Type:Individual
Prefix:DR
First Name:KEENAN
Middle Name:
Last Name:SMART
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2911 ADAMS RD STE 101
Mailing Address - Street 2:
Mailing Address - City:NORMAN
Mailing Address - State:OK
Mailing Address - Zip Code:73069-1023
Mailing Address - Country:US
Mailing Address - Phone:405-310-3735
Mailing Address - Fax:405-310-3576
Practice Address - Street 1:2911 ADAMS RD STE 101
Practice Address - Street 2:
Practice Address - City:NORMAN
Practice Address - State:OK
Practice Address - Zip Code:73069-1023
Practice Address - Country:US
Practice Address - Phone:405-310-3735
Practice Address - Fax:405-310-3576
Is Sole Proprietor?:No
Enumeration Date:2013-05-08
Last Update Date:2024-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK300612084P0804X, 2084P0800X
ORMD1775232084P0804X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0804XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyChild & Adolescent Psychiatry
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry