Healthcare Provider Details

I. General information

NPI: 1912813197
Provider Name (Legal Business Name): SABRA PALOMARES LPN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/19/2026
Last Update Date: 08/19/2026
Certification Date: 08/19/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

781 GRAND CASINO BLVD
SHAWNEE OK
74804-1005
US

IV. Provider business mailing address

29214 CLEARPOND RD
MCLOUD OK
74851-9312
US

V. Phone/Fax

Practice location:
  • Phone: 405-273-5236
  • Fax:
Mailing address:
  • Phone: 405-273-5236
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code164W00000X
TaxonomyLicensed Practical Nurse
License Number25877168
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: