Provider Demographics
NPI:1972803583
Name:SMITH, TIFFANY L (NP)
Entity Type:Individual
Prefix:MRS
First Name:TIFFANY
Middle Name:L
Last Name:SMITH
Suffix:
Gender:F
Credentials:NP
Other - Prefix:MISS
Other - First Name:TIFFANY
Other - Middle Name:LEE
Other - Last Name:HANSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:3400 E FRANK PHILLIPS BLVD
Mailing Address - Street 2:STE 601
Mailing Address - City:BARTLESVILLE
Mailing Address - State:OK
Mailing Address - Zip Code:74006-2442
Mailing Address - Country:US
Mailing Address - Phone:918-331-2599
Mailing Address - Fax:
Practice Address - Street 1:3400 FRANK PHILLIPS
Practice Address - Street 2:SUITE 601
Practice Address - City:BARTLESVILLE
Practice Address - State:OK
Practice Address - Zip Code:74006
Practice Address - Country:US
Practice Address - Phone:918-331-2599
Practice Address - Fax:918-331-2598
Is Sole Proprietor?:No
Enumeration Date:2010-10-28
Last Update Date:2016-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK92149363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK200328140AMedicaid