Provider Demographics
NPI:1336954312
Name:SMITH, ELIZABETH E
Entity type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:E
Last Name:SMITH
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:20624 E 44TH ST UNIT 27
Mailing Address - Street 2:
Mailing Address - City:YALE
Mailing Address - State:OK
Mailing Address - Zip Code:74085-6921
Mailing Address - Country:US
Mailing Address - Phone:918-904-1167
Mailing Address - Fax:
Practice Address - Street 1:998 E KNOTTS AVE
Practice Address - Street 2:
Practice Address - City:STILLWATER
Practice Address - State:OK
Practice Address - Zip Code:74075-3023
Practice Address - Country:US
Practice Address - Phone:844-458-2100
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-02-08
Last Update Date:2025-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK175T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175T00000XOther Service ProvidersPeer Specialist