Provider Demographics
NPI:1316708522
Name:LAXTON, MIRANDA L (APRN-CNP)
Entity type:Individual
Prefix:
First Name:MIRANDA
Middle Name:L
Last Name:LAXTON
Suffix:
Gender:F
Credentials:APRN-CNP
Other - Prefix:
Other - First Name:MIRANDA
Other - Middle Name:
Other - Last Name:GERMANY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:108 W MAIN ST
Mailing Address - Street 2:
Mailing Address - City:TISHOMINGO
Mailing Address - State:OK
Mailing Address - Zip Code:73460-1723
Mailing Address - Country:US
Mailing Address - Phone:580-774-3548
Mailing Address - Fax:
Practice Address - Street 1:1521 BAKER RD
Practice Address - Street 2:
Practice Address - City:SHERMAN
Practice Address - State:TX
Practice Address - Zip Code:75090-2409
Practice Address - Country:US
Practice Address - Phone:903-891-1972
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-01-16
Last Update Date:2025-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1176397363LF0000X
OK216284363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily