Healthcare Provider Details

I. General information

NPI: 1932031465
Provider Name (Legal Business Name): SAGE PRIMARY HEALTH PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/01/2026
Last Update Date: 06/01/2026
Certification Date: 05/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

20213 NE 23RD ST STE B1
HARRAH OK
73045-9144
US

IV. Provider business mailing address

PO BOX 156
HARRAH OK
73045-0156
US

V. Phone/Fax

Practice location:
  • Phone: 405-347-9017
  • Fax:
Mailing address:
  • Phone: 405-347-9017
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: JENNIFER GLENN
Title or Position: OWNER
Credential:
Phone: 405-347-9017