Provider Demographics
NPI:1952929515
Name:SMITH, TASHA SHEA (RN)
Entity type:Individual
Prefix:
First Name:TASHA
Middle Name:SHEA
Last Name:SMITH
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:TASHA
Other - Middle Name:SHEA
Other - Last Name:LEATHERMAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2225 N. UNION
Mailing Address - Street 2:
Mailing Address - City:PONCA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:74601-1536
Mailing Address - Country:US
Mailing Address - Phone:580-308-5515
Mailing Address - Fax:580-749-5792
Practice Address - Street 1:2225 N. UNION
Practice Address - Street 2:
Practice Address - City:PONCA CITY
Practice Address - State:OK
Practice Address - Zip Code:74601-1536
Practice Address - Country:US
Practice Address - Phone:580-308-5515
Practice Address - Fax:580-749-5792
Is Sole Proprietor?:No
Enumeration Date:2020-07-10
Last Update Date:2020-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK109192163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse