Healthcare Provider Details

I. General information

NPI: 1316708522
Provider Name (Legal Business Name): MIRANDA L LAXTON APRN-CNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MIRANDA GERMANY

II. Dates (important events)

Enumeration Date: 01/16/2024
Last Update Date: 01/08/2025
Certification Date: 01/08/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1521 BAKER RD
SHERMAN TX
75090-2409
US

IV. Provider business mailing address

108 W MAIN ST
TISHOMINGO OK
73460-1723
US

V. Phone/Fax

Practice location:
  • Phone: 903-891-1972
  • Fax:
Mailing address:
  • Phone: 580-774-3548
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number1176397
License Number StateTX
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number216284
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: