Provider Demographics
NPI:1366515389
Name:LAUGHLIN, MYNA RUTH (ARNP)
Entity type:Individual
Prefix:MRS
First Name:MYNA
Middle Name:RUTH
Last Name:LAUGHLIN
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:135 BRANDI LN
Mailing Address - Street 2:
Mailing Address - City:DURANT
Mailing Address - State:OK
Mailing Address - Zip Code:74701-7404
Mailing Address - Country:US
Mailing Address - Phone:580-920-8504
Mailing Address - Fax:
Practice Address - Street 1:1705 N WASHINGTON AVE STE C
Practice Address - Street 2:
Practice Address - City:DURANT
Practice Address - State:OK
Practice Address - Zip Code:74701-2100
Practice Address - Country:US
Practice Address - Phone:580-924-5439
Practice Address - Fax:580-366-5439
Is Sole Proprietor?:No
Enumeration Date:2006-11-16
Last Update Date:2023-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX530454363LA2100X
OKRR0045593363LP0200X
OK45593363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care
No363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX530454OtherTEXAS LICENSE
OKR0045593OtherOK NURSING LICENSE
OK200101720AMedicaid