Healthcare Provider Details

I. General information

NPI: 1225799935
Provider Name (Legal Business Name): RYAN HIGHTOWER APRN-CNP
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/05/2022
Last Update Date: 04/30/2026
Certification Date: 04/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2603 SW 119TH ST
OKLAHOMA CITY OK
73170-2628
US

IV. Provider business mailing address

PO BOX 776084
CHICAGO IL
60677-6084
US

V. Phone/Fax

Practice location:
  • Phone: 405-378-5752
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number206387
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: