Healthcare Provider Details

I. General information

NPI: 1265972822
Provider Name (Legal Business Name): SARA BUSTER
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/01/2017
Last Update Date: 05/10/2021
Certification Date: 05/10/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

304 S 29TH ST
CHICKASHA OK
73018-2501
US

IV. Provider business mailing address

304 S 29TH ST
CHICKASHA OK
73018-2501
US

V. Phone/Fax

Practice location:
  • Phone: 405-816-8058
  • Fax: 855-223-1999
Mailing address:
  • Phone: 405-896-8058
  • Fax: 855-223-1999

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number110831
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: