Provider Demographics
NPI:1952776569
Name:SMITH, BARBARA LYNN (APRN-CNP)
Entity type:Individual
Prefix:
First Name:BARBARA
Middle Name:LYNN
Last Name:SMITH
Suffix:
Gender:F
Credentials:APRN-CNP
Other - Prefix:
Other - First Name:BARBIE
Other - Middle Name:
Other - Last Name:SMITH
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:1 E CLARK BASS BLVD
Mailing Address - Street 2:
Mailing Address - City:MCALESTER
Mailing Address - State:OK
Mailing Address - Zip Code:74501-4209
Mailing Address - Country:US
Mailing Address - Phone:918-421-6960
Mailing Address - Fax:918-421-6094
Practice Address - Street 1:3 E CLARK BASS BLVD
Practice Address - Street 2:SUITE 2
Practice Address - City:MCALESTER
Practice Address - State:OK
Practice Address - Zip Code:74501-4283
Practice Address - Country:US
Practice Address - Phone:918-421-6960
Practice Address - Fax:918-421-6094
Is Sole Proprietor?:No
Enumeration Date:2015-12-08
Last Update Date:2020-09-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK102201363L00000X, 363L00000X
CORN.1635911163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK200626060AMedicaid
OK469186ZNWEMedicare PIN