Provider Demographics
NPI:1922086149
Name:SMOTHERS, KRISTY M (ARNP)
Entity Type:Individual
Prefix:
First Name:KRISTY
Middle Name:M
Last Name:SMOTHERS
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2149 ED F DAVIS RD
Mailing Address - Street 2:
Mailing Address - City:DURANT
Mailing Address - State:OK
Mailing Address - Zip Code:74701-3085
Mailing Address - Country:US
Mailing Address - Phone:580-931-8180
Mailing Address - Fax:580-931-8015
Practice Address - Street 1:2149 ED F DAVIS RD
Practice Address - Street 2:
Practice Address - City:DURANT
Practice Address - State:OK
Practice Address - Zip Code:74701-3085
Practice Address - Country:US
Practice Address - Phone:580-931-8180
Practice Address - Fax:580-931-8015
Is Sole Proprietor?:No
Enumeration Date:2006-01-06
Last Update Date:2024-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OKR0062038363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK200060820AMedicaid
OKP00260545OtherRAILROAD MEDICARE
OK200060820AMedicaid
245711504Medicare PIN
OK247527602Medicare PIN