Provider Demographics
NPI:1295178911
Name:KANARY, SARA ELIZABETH (MED)
Entity Type:Individual
Prefix:MISS
First Name:SARA
Middle Name:ELIZABETH
Last Name:KANARY
Suffix:
Gender:F
Credentials:MED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6900 BASSWOOD CANYON RD
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73162-7207
Mailing Address - Country:US
Mailing Address - Phone:405-922-9055
Mailing Address - Fax:
Practice Address - Street 1:3005 NW 63RD ST
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73116-3603
Practice Address - Country:US
Practice Address - Phone:405-521-1755
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-04-11
Last Update Date:2013-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health