Healthcare Provider Details

I. General information

NPI: 1407978653
Provider Name (Legal Business Name): SARAH BROOKE PINSON P.A.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/06/2007
Last Update Date: 05/06/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

700 W 7TH AVE STE 101
BRISTOW OK
74010-2302
US

IV. Provider business mailing address

700 W 7TH AVE STE 101
BRISTOW OK
74010-2302
US

V. Phone/Fax

Practice location:
  • Phone: 918-367-3272
  • Fax: 918-367-5275
Mailing address:
  • Phone: 918-367-3272
  • Fax: 918-367-5275

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number1622
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: