Provider Demographics
NPI:1295016343
Name:SMITH HALPINE, LAKETA (DO)
Entity type:Individual
Prefix:
First Name:LAKETA
Middle Name:
Last Name:SMITH HALPINE
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:LAKETA
Other - Middle Name:
Other - Last Name:SMITH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DO
Mailing Address - Street 1:7010 S. UTICA AVE.
Mailing Address - Street 2:
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74136-3904
Mailing Address - Country:US
Mailing Address - Phone:918-764-9220
Mailing Address - Fax:918-764-9214
Practice Address - Street 1:7010 S. UTICA AVE.
Practice Address - Street 2:
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74136-3904
Practice Address - Country:US
Practice Address - Phone:918-764-9220
Practice Address - Fax:918-764-9214
Is Sole Proprietor?:Yes
Enumeration Date:2011-09-02
Last Update Date:2013-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK5289208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK200401150BMedicaid