Healthcare Provider Details

I. General information

NPI: 1922746015
Provider Name (Legal Business Name): SARAH ELISSE JEWITT APRN-CNP, PMHNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: SARAH ELISSE GARDER

II. Dates (important events)

Enumeration Date: 05/26/2022
Last Update Date: 09/12/2024
Certification Date: 09/12/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13301 N MERIDIAN AVE STE 100
OKLAHOMA CITY OK
73120-8357
US

IV. Provider business mailing address

1008 24TH AVE NW
NORMAN OK
73069-6369
US

V. Phone/Fax

Practice location:
  • Phone: 405-310-3262
  • Fax:
Mailing address:
  • Phone: 405-310-3262
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number207985
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: