Healthcare Provider Details

I. General information

NPI: 1063983740
Provider Name (Legal Business Name): AMY ALANE MIKLES PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/06/2018
Last Update Date: 09/19/2026
Certification Date: 09/19/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2919 S DIVISION ST
GUTHRIE OK
73044-6806
US

IV. Provider business mailing address

2919 S DIVISION ST
GUTHRIE OK
73044-6806
US

V. Phone/Fax

Practice location:
  • Phone: 405-282-6301
  • Fax:
Mailing address:
  • Phone: 405-282-6301
  • Fax: 405-282-6364

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number2929
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: