Healthcare Provider Details

I. General information

NPI: 1255273942
Provider Name (Legal Business Name): MIA WOODSON
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/09/2026
Last Update Date: 04/09/2026
Certification Date: 04/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

20308 E 41ST PL S
BROKEN ARROW OK
74014-1268
US

IV. Provider business mailing address

20308 E 41ST PL S
BROKEN ARROW OK
74014-1268
US

V. Phone/Fax

Practice location:
  • Phone: 314-495-4274
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code374J00000X
TaxonomyDoula
License Number
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: