MEDICARE: SARA LOUISE WHITESHIELD

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	171M00000X	Case Manager/Care Coordinator

General Provider Information

NPI Number	:	1275268385
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SARA LOUISE WHITESHIELD

Provider Business Mailing Address
First Line	:	PO BOX 2001
Second Line	:
City	:	WEATHERFORD
State	:	OK
Zip	:	73096-8001
Country	:	US
Telephone Number	:	580-448-0158
Fax Number	:

Provider Business Practice Location Address
First Line	:	122 S 8TH ST
Second Line	:
City	:	WEATHERFORD
State	:	OK
Zip	:	73096-4808
Country	:	US
Telephone Number	:	580-448-0158
Fax Number	:

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

Provider Enumeration Date	:	07/21/2022
Last Update Date	:	07/21/2022

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Directions to “ SARA LOUISE WHITESHIELD ” Practice Location

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