Provider Demographics
NPI:1033460449
Name:BUNTIN, SARA ANN (MSN, APRN, PNP-PC)
Entity Type:Individual
Prefix:
First Name:SARA
Middle Name:ANN
Last Name:BUNTIN
Suffix:
Gender:F
Credentials:MSN, APRN, PNP-PC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12324 E 86TH ST N # 472
Mailing Address - Street 2:
Mailing Address - City:OWASSO
Mailing Address - State:OK
Mailing Address - Zip Code:74055-2543
Mailing Address - Country:US
Mailing Address - Phone:918-605-8609
Mailing Address - Fax:
Practice Address - Street 1:13600 E 86TH ST N STE 200
Practice Address - Street 2:
Practice Address - City:OWASSO
Practice Address - State:OK
Practice Address - Zip Code:74055-8732
Practice Address - Country:US
Practice Address - Phone:918-609-5700
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-09-25
Last Update Date:2024-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK83204163W00000X, 2080A0000X, 2080A0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080A0000XAllopathic & Osteopathic PhysiciansPediatricsAdolescent Medicine
No163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK83204OtherSTATE LICENSE