Provider Demographics
NPI:1922474923
Name:SMITH, KACI (LPN)
Entity Type:Individual
Prefix:
First Name:KACI
Middle Name:
Last Name:SMITH
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1217 W GARY BLVD
Mailing Address - Street 2:
Mailing Address - City:CLINTON
Mailing Address - State:OK
Mailing Address - Zip Code:73601-2727
Mailing Address - Country:US
Mailing Address - Phone:580-383-7608
Mailing Address - Fax:580-547-4076
Practice Address - Street 1:1217 W GARY BLVD
Practice Address - Street 2:
Practice Address - City:CLINTON
Practice Address - State:OK
Practice Address - Zip Code:73601-2727
Practice Address - Country:US
Practice Address - Phone:580-383-7608
Practice Address - Fax:580-547-4076
Is Sole Proprietor?:Yes
Enumeration Date:2015-08-13
Last Update Date:2015-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK0060595164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse