Provider Demographics
NPI:1881334878
Name:SMITH, LACY BROOKE (ARNP, CPNP-AC)
Entity type:Individual
Prefix:
First Name:LACY
Middle Name:BROOKE
Last Name:SMITH
Suffix:
Gender:F
Credentials:ARNP, CPNP-AC
Other - Prefix:
Other - First Name:LACY
Other - Middle Name:BROOKE
Other - Last Name:MCCAIG
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:921 S LINFORD DR
Mailing Address - Street 2:
Mailing Address - City:STILLWATER
Mailing Address - State:OK
Mailing Address - Zip Code:74074-5863
Mailing Address - Country:US
Mailing Address - Phone:405-612-6910
Mailing Address - Fax:
Practice Address - Street 1:1200 CHILDRENS AVE
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73104-4637
Practice Address - Country:US
Practice Address - Phone:405-417-2225
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-03-29
Last Update Date:2024-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OKR0109120163WC0200X
WAAP61620861363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute CareGroup - Multi-Specialty
No163WC0200XNursing Service ProvidersRegistered NurseCritical Care Medicine