Healthcare Provider Details

I. General information

NPI: 1053245431
Provider Name (Legal Business Name): SARAH BOEDECKER
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/10/2026
Last Update Date: 08/05/2026
Certification Date: 08/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

520 S MUSTANG RD
YUKON OK
73099-6737
US

IV. Provider business mailing address

6300 BENTLEY DR
OKLAHOMA CITY OK
73169-6916
US

V. Phone/Fax

Practice location:
  • Phone: 405-936-5910
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number213451
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: