MEDICARE: SARAH CHRISTINE OGLESBY

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	163WG0000X	General Practice Registered Nurse	R0111038	OK
2	363L00000X	Nurse Practitioner	222886	OK
3	207Q00000X	Family Medicine Physician	222886	OK

General Provider Information

NPI Number	:	1275345027
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SARAH CHRISTINE OGLESBY

Provider Business Mailing Address
First Line	:	817 S ELM PL STE 106
Second Line	:
City	:	BROKEN ARROW
State	:	OK
Zip	:	74012-5369
Country	:	US
Telephone Number	:	918-928-5437
Fax Number	:

Provider Business Practice Location Address
First Line	:	817 S ELM PL STE 106
Second Line	:
City	:	BROKEN ARROW
State	:	OK
Zip	:	74012-5369
Country	:	US
Telephone Number	:	918-928-5437
Fax Number	:

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

Provider Enumeration Date	:	01/20/2025
Last Update Date	:	01/07/2026

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