1972803583 NPI number — MRS. TIFFANY L SMITH NP

Table of content: MRS. TIFFANY L SMITH NP (NPI 1972803583)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1972803583 NPI number — MRS. TIFFANY L SMITH NP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
SMITH
Provider First Name:
TIFFANY
Provider Middle Name:
L
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
NP
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
HANSON
Provider Other First Name:
TIFFANY
Provider Other Middle Name:
LEE
Provider Other Name Prefix Text:
MISS
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1972803583
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
10/06/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3400 E FRANK PHILLIPS BLVD
Provider Second Line Business Mailing Address:
STE 601
Provider Business Mailing Address City Name:
BARTLESVILLE
Provider Business Mailing Address State Name:
OK
Provider Business Mailing Address Postal Code:
74006-2442
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
918-331-2599
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3400 FRANK PHILLIPS
Provider Second Line Business Practice Location Address:
SUITE 601
Provider Business Practice Location Address City Name:
BARTLESVILLE
Provider Business Practice Location Address State Name:
OK
Provider Business Practice Location Address Postal Code:
74006
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
918-331-2599
Provider Business Practice Location Address Fax Number:
918-331-2598
Provider Enumeration Date:
10/28/2010

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 363LA2200X , with the licence number:  92149 , registered in the state of OK ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 200328140A , issued by the state of ( OK ) . This identifiers is of the category "MEDICAID".




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