Healthcare Provider Details

I. General information

NPI: 1114863081
Provider Name (Legal Business Name): MOONLIT MENTAL HEALTH LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/24/2026
Last Update Date: 04/24/2026
Certification Date: 04/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2249 W WASHINGTON ST
BROKEN ARROW OK
74012-6703
US

IV. Provider business mailing address

2249 W WASHINGTON ST
BROKEN ARROW OK
74012-6703
US

V. Phone/Fax

Practice location:
  • Phone: 903-471-7546
  • Fax:
Mailing address:
  • Phone: 903-471-7546
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: MRS. SARAH ABIGAIL WOODY
Title or Position: PMHNP-BC
Credential: PMHNP-BC
Phone: 903-471-7546