Provider Demographics
NPI:1891068938
Name:SMITH, SHARON L (APRN)
Entity Type:Individual
Prefix:
First Name:SHARON
Middle Name:L
Last Name:SMITH
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1150 E LANSING ST
Mailing Address - Street 2:SUITE 201
Mailing Address - City:BROKEN ARROW
Mailing Address - State:OK
Mailing Address - Zip Code:74012-2429
Mailing Address - Country:US
Mailing Address - Phone:918-921-7661
Mailing Address - Fax:918-921-7662
Practice Address - Street 1:1150 E LANSING ST
Practice Address - Street 2:
Practice Address - City:BROKEN ARROW
Practice Address - State:OK
Practice Address - Zip Code:74012-2429
Practice Address - Country:US
Practice Address - Phone:918-921-7661
Practice Address - Fax:918-921-7662
Is Sole Proprietor?:No
Enumeration Date:2012-02-21
Last Update Date:2019-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OKR103794363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK332898YLM3OtherMEDICARE PTAN
OK332898YXXJOtherMEDICARE PTAN
OK200436210AMedicaid