Healthcare Provider Details

I. General information

NPI: 1649058991
Provider Name (Legal Business Name): SARAH WILKINSON
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/18/2023
Last Update Date: 07/15/2026
Certification Date: 07/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1400 BRYAN DR STE 201
DURANT OK
74701-2157
US

IV. Provider business mailing address

372 URY RD
CADDO OK
74729-4105
US

V. Phone/Fax

Practice location:
  • Phone: 580-924-5500
  • Fax:
Mailing address:
  • Phone: 913-212-8587
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number9674
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: