Healthcare Provider Details

I. General information

NPI: 1215529078
Provider Name (Legal Business Name): MIRANDA HIGH
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/03/2021
Last Update Date: 09/11/2026
Certification Date: 09/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

632 WILDWOOD DR
TUTTLE OK
73089-8568
US

IV. Provider business mailing address

2724 BUSHEYWOOD DR
YUKON OK
73099-9755
US

V. Phone/Fax

Practice location:
  • Phone: 405-294-3522
  • Fax: 501-904-8783
Mailing address:
  • Phone: 405-294-3522
  • Fax: 501-904-8783

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number220733
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: