Healthcare Provider Details

I. General information

NPI: 1780536813
Provider Name (Legal Business Name): TAYLOR RAVEN FISHER
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/11/2026
Last Update Date: 02/11/2026
Certification Date: 02/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

532 SUE LN
MCLOUD OK
74851-8221
US

IV. Provider business mailing address

532 SUE LN
MCLOUD OK
74851-8221
US

V. Phone/Fax

Practice location:
  • Phone: 405-532-4942
  • Fax:
Mailing address:
  • Phone: 405-532-4942
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code175T00000X
TaxonomyPeer Specialist
License Number
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: