Provider Demographics
NPI:1568244655
Name:SMOOT, MIRANDA ALBERTA IRENE (APRN)
Entity type:Individual
Prefix:
First Name:MIRANDA
Middle Name:ALBERTA IRENE
Last Name:SMOOT
Suffix:
Gender:
Credentials:APRN
Other - Prefix:
Other - First Name:MIRANDA
Other - Middle Name:ALBERTA IRENE
Other - Last Name:HARTING
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:218 E ARAPAHO AVE APT 8
Mailing Address - Street 2:
Mailing Address - City:WEATHERFORD
Mailing Address - State:OK
Mailing Address - Zip Code:73096-5128
Mailing Address - Country:US
Mailing Address - Phone:405-408-4960
Mailing Address - Fax:
Practice Address - Street 1:1701 S 4TH ST
Practice Address - Street 2:
Practice Address - City:CLINTON
Practice Address - State:OK
Practice Address - Zip Code:73601-2309
Practice Address - Country:US
Practice Address - Phone:580-331-2200
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-10-16
Last Update Date:2025-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QV0200XAmbulatory Health Care FacilitiesClinic/CenterVA
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program