Healthcare Provider Details

I. General information

NPI: 1699654012
Provider Name (Legal Business Name): MYKAH RAELEIGH SWAIM
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/29/2025
Last Update Date: 08/28/2026
Certification Date: 08/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

614 S MAIN ST
STILLWATER OK
74074-4059
US

IV. Provider business mailing address

3515 E FAIRMONT ST
BROKEN ARROW OK
74014-8848
US

V. Phone/Fax

Practice location:
  • Phone: 405-564-3408
  • Fax:
Mailing address:
  • Phone: 405-593-4265
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: