Provider Demographics
NPI:1962193565
Name:SMITH, RAINEY MICHELLE
Entity type:Individual
Prefix:
First Name:RAINEY
Middle Name:MICHELLE
Last Name:SMITH
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:RAINEY
Other - Middle Name:MICHELLE
Other - Last Name:PORTERFIELD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 1710
Mailing Address - Street 2:
Mailing Address - City:KINGSTON
Mailing Address - State:OK
Mailing Address - Zip Code:73439-1710
Mailing Address - Country:US
Mailing Address - Phone:580-795-3794
Mailing Address - Fax:855-286-8580
Practice Address - Street 1:717 HIGHWAY 70 E
Practice Address - Street 2:
Practice Address - City:KINGSTON
Practice Address - State:OK
Practice Address - Zip Code:73439-8253
Practice Address - Country:US
Practice Address - Phone:580-795-3794
Practice Address - Fax:855-286-8580
Is Sole Proprietor?:No
Enumeration Date:2023-05-16
Last Update Date:2023-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator