Provider Demographics
NPI:1871014886
Name:SMITH, TANESIA MICHELLE
Entity Type:Individual
Prefix:MRS
First Name:TANESIA
Middle Name:MICHELLE
Last Name:SMITH
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2629 W I 44 SERVICE RD STE 202
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73112-3762
Mailing Address - Country:US
Mailing Address - Phone:405-605-1865
Mailing Address - Fax:
Practice Address - Street 1:2629 W I44 SERVICE RD
Practice Address - Street 2:SUITE 202
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73112
Practice Address - Country:US
Practice Address - Phone:405-605-1865
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-06-29
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management