MEDICARE: RYAN HIGHTOWER APRN-CNP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363L00000X	Nurse Practitioner	206387	OK

General Provider Information

NPI Number	:	1225799935
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	RYAN HIGHTOWER APRN-CNP

Provider Business Mailing Address
First Line	:	PO BOX 776084
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60677-6084
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	2603 SW 119TH ST
Second Line	:
City	:	OKLAHOMA CITY
State	:	OK
Zip	:	73170-2628
Country	:	US
Telephone Number	:	405-378-5752
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/05/2022
Last Update Date	:	04/30/2026

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