Provider Demographics
NPI:1093086548
Name:HATTAWAY, SARA RENEE' (PA-C)
Entity Type:Individual
Prefix:MRS
First Name:SARA
Middle Name:RENEE'
Last Name:HATTAWAY
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:SARA
Other - Middle Name:RENEE'
Other - Last Name:VOWELS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA-C
Mailing Address - Street 1:6600 S YALE AVE STE 1400
Mailing Address - Street 2:
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74136-3331
Mailing Address - Country:US
Mailing Address - Phone:888-247-0125
Mailing Address - Fax:918-502-8210
Practice Address - Street 1:6475 S YALE AVE STE 401
Practice Address - Street 2:
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74136-7818
Practice Address - Country:US
Practice Address - Phone:918-502-9555
Practice Address - Fax:918-502-9559
Is Sole Proprietor?:No
Enumeration Date:2012-01-14
Last Update Date:2023-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK2105363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical