Healthcare Provider Details

I. General information

NPI: 1164533915
Provider Name (Legal Business Name): HAYDEN MILLER CCP
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/31/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3601 N MAY AVE SUITE C
OKLAHOMA CITY OK
73112-6641
US

IV. Provider business mailing address

3601 N MAY AVE SUITE C
OKLAHOMA CITY OK
73112-6641
US

V. Phone/Fax

Practice location:
  • Phone: 405-601-0954
  • Fax: 405-601-3750
Mailing address:
  • Phone: 405-604-5613
  • Fax: 405-601-3750

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License NumberLP71
License Number StateOK
# 2
Primary TaxonomyN
Taxonomy Code174400000X
TaxonomySpecialist
License Number1799
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: