Healthcare Provider Details

I. General information

NPI: 1205542461
Provider Name (Legal Business Name): SARAH ERVIN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/30/2023
Last Update Date: 04/28/2025
Certification Date: 04/28/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

301 NW 63RD ST STE 650
OKLAHOMA CITY OK
73116-7915
US

IV. Provider business mailing address

5418 SW VICTORIA BLVD
LAWTON OK
73505-5751
US

V. Phone/Fax

Practice location:
  • Phone: 405-842-4435
  • Fax: 405-842-2846
Mailing address:
  • Phone: 580-695-0927
  • Fax: 405-842-2846

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberR0116433
License Number StateOK
# 2
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number220528
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: