Provider Demographics
NPI:1386048866
Name:SMITH, SCOTTIE LYNN (APRN)
Entity type:Individual
Prefix:MRS
First Name:SCOTTIE
Middle Name:LYNN
Last Name:SMITH
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:MS
Other - First Name:SCOTTIE
Other - Middle Name:LYNN
Other - Last Name:BUCKNER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:APRN
Mailing Address - Street 1:3366 NW EXPRESSWAY
Mailing Address - Street 2:BUILDING D, SUITE 400
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73112
Mailing Address - Country:US
Mailing Address - Phone:405-702-1300
Mailing Address - Fax:405-429-7527
Practice Address - Street 1:3300 NW EXPRESSWAY
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73112-4418
Practice Address - Country:US
Practice Address - Phone:405-503-8312
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-10-13
Last Update Date:2015-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK81385363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care