Provider Demographics
NPI:1487900668
Name:SMITH, ALISHA BROOKE (APRN-CNP)
Entity type:Individual
Prefix:
First Name:ALISHA
Middle Name:BROOKE
Last Name:SMITH
Suffix:
Gender:F
Credentials:APRN-CNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18961 NE 23RD ST
Mailing Address - Street 2:
Mailing Address - City:HARRAH
Mailing Address - State:OK
Mailing Address - Zip Code:73045-8109
Mailing Address - Country:US
Mailing Address - Phone:405-390-1800
Mailing Address - Fax:405-390-3846
Practice Address - Street 1:18961 NE 23RD ST
Practice Address - Street 2:
Practice Address - City:HARRAH
Practice Address - State:OK
Practice Address - Zip Code:73045-8109
Practice Address - Country:US
Practice Address - Phone:405-390-1800
Practice Address - Fax:405-390-3846
Is Sole Proprietor?:No
Enumeration Date:2012-07-25
Last Update Date:2023-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK75434163W00000X, 363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163W00000XNursing Service ProvidersRegistered Nurse