MEDICARE: SUSAN ELAINE HIGHTOWER APRN

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	363LF0000X	Family Nurse Practitioner	107079	OK

General Provider Information

NPI Number	:	1588297709
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SUSAN ELAINE HIGHTOWER APRN

Provider Business Mailing Address
First Line	:	14021 CROSSING WAY E
Second Line	:
City	:	EDMOND
State	:	OK
Zip	:	73013-4731
Country	:	US
Telephone Number	:	405-401-5882
Fax Number	:

Provider Business Practice Location Address
First Line	:	1303 N WASHINGTON ST
Second Line	:
City	:	WEATHERFORD
State	:	OK
Zip	:	73096-2443
Country	:	US
Telephone Number	:	580-772-2820
Fax Number	:

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

Provider Enumeration Date	:	02/17/2020
Last Update Date	:	02/17/2020

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