Provider Demographics
NPI:1700107109
Name:SMITH, MARY JANE (CRNP)
Entity Type:Individual
Prefix:MS
First Name:MARY
Middle Name:JANE
Last Name:SMITH
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:MS
Other - First Name:MARY
Other - Middle Name:JANE
Other - Last Name:BYRAM
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:ANRP CNP
Mailing Address - Street 1:6600 S YALE AVE
Mailing Address - Street 2:SUITE 750
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74136-3347
Mailing Address - Country:US
Mailing Address - Phone:918-502-8383
Mailing Address - Fax:918-502-8385
Practice Address - Street 1:6600 S YALE AVE
Practice Address - Street 2:SUITE 750
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74136-3347
Practice Address - Country:US
Practice Address - Phone:918-502-8383
Practice Address - Fax:918-502-8385
Is Sole Proprietor?:No
Enumeration Date:2010-06-20
Last Update Date:2013-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK0104883363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care