Provider Demographics
NPI:1093589640
Name:OKLAHOMA KIDS PEDIATRICS, SARA BUNTIN, APRN-CPNP, PLLC
Entity Type:Organization
Organization Name:OKLAHOMA KIDS PEDIATRICS, SARA BUNTIN, APRN-CPNP, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER, APRN, CPNP
Authorized Official - Prefix:
Authorized Official - First Name:SARA
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:BUNTIN
Authorized Official - Suffix:
Authorized Official - Credentials:APRN, CPNP
Authorized Official - Phone:918-605-8609
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 1:11737 N 117TH EAST AVE
Practice Address - Street 2:
Practice Address - City:COLLINSVILLE
Practice Address - State:OK
Practice Address - Zip Code:74021-1007
Practice Address - Country:US
Practice Address - Phone:918-605-8609
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-11-13
Last Update Date:2023-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care