Healthcare Provider Details

I. General information

NPI: 1639692254
Provider Name (Legal Business Name): SHAWN DAVID SAGER NURSE PRACTITIONER
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/25/2017
Last Update Date: 04/01/2025
Certification Date: 03/31/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1801 E KENOSHA ST
BROKEN ARROW OK
74012-2098
US

IV. Provider business mailing address

6600 S YALE AVE STE 1200
TULSA OK
74136-3361
US

V. Phone/Fax

Practice location:
  • Phone: 918-449-4150
  • Fax: 918-449-4107
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number77810
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: