Healthcare Provider Details

I. General information

NPI: 1710842232
Provider Name (Legal Business Name): SANDERSON HEALTH CENTER LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/17/2025
Last Update Date: 12/17/2025
Certification Date: 12/17/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

315 W 9TH ST
WELEETKA OK
74880-8117
US

IV. Provider business mailing address

PO BOX 276
WELEETKA OK
74880-0276
US

V. Phone/Fax

Practice location:
  • Phone: 405-786-2248
  • Fax: 405-786-2006
Mailing address:
  • Phone: 405-786-2248
  • Fax: 405-786-2006

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QR1300X
TaxonomyRural Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: KIMBER MARIE SANDERSON
Title or Position: OWNER/ PROVIDER
Credential: APRN-CNP
Phone: 405-584-1071