Healthcare Provider Details

I. General information

NPI: 1316856768
Provider Name (Legal Business Name): SARAH JOHNSON
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/02/2026
Last Update Date: 09/02/2026
Certification Date: 09/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1011 HONOR HEIGHTS DR
MUSKOGEE OK
74401-1318
US

IV. Provider business mailing address

15504 E 87TH PL N
OWASSO OK
74055-9409
US

V. Phone/Fax

Practice location:
  • Phone: 918-577-1722
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WC0200X
TaxonomyCritical Care Medicine Registered Nurse
License NumberR0092833
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: