Provider Demographics
NPI:1821542200
Name:SMITH, CHRISTIE JEAN (RN)
Entity Type:Individual
Prefix:MRS
First Name:CHRISTIE
Middle Name:JEAN
Last Name:SMITH
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:29 RAINTREE ST
Mailing Address - Street 2:
Mailing Address - City:PONCA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:74604-5414
Mailing Address - Country:US
Mailing Address - Phone:580-716-8975
Mailing Address - Fax:580-762-0631
Practice Address - Street 1:29 RAINTREE ST
Practice Address - Street 2:
Practice Address - City:PONCA CITY
Practice Address - State:OK
Practice Address - Zip Code:74604-5414
Practice Address - Country:US
Practice Address - Phone:580-716-8975
Practice Address - Fax:580-762-0631
Is Sole Proprietor?:No
Enumeration Date:2016-08-15
Last Update Date:2016-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OKR00922911041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical