Healthcare Provider Details

I. General information

NPI: 1588379671
Provider Name (Legal Business Name): MIKAELA WINTZ APRN-CNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/23/2023
Last Update Date: 11/18/2025
Certification Date: 11/18/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1323 W 6TH AVE
STILLWATER OK
74074-4306
US

IV. Provider business mailing address

PO BOX 802738
KANSAS CITY MO
64180-2738
US

V. Phone/Fax

Practice location:
  • Phone: 405-533-3010
  • Fax:
Mailing address:
  • Phone: 918-399-3627
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number214908
License Number StateOK
# 2
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number266189
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: