Healthcare Provider Details

I. General information

NPI: 1649908930
Provider Name (Legal Business Name): SARAH LYNN CLOSE APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/12/2022
Last Update Date: 03/31/2023
Certification Date: 03/31/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

395090 W 2950 DR
OCHELATA OK
74051-2500
US

IV. Provider business mailing address

395200 W 2900 RD
OCHELATA OK
74051-2463
US

V. Phone/Fax

Practice location:
  • Phone: 918-766-5879
  • Fax:
Mailing address:
  • Phone: 918-535-6000
  • Fax: 918-535-2367

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number209820
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: