Provider Demographics
NPI:1407978653
Name:PINSON, SARAH BROOKE (PA)
Entity Type:Individual
Prefix:
First Name:SARAH
Middle Name:BROOKE
Last Name:PINSON
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:700 W 7TH AVE
Mailing Address - Street 2:STE 101
Mailing Address - City:BRISTOW
Mailing Address - State:OK
Mailing Address - Zip Code:74010-2302
Mailing Address - Country:US
Mailing Address - Phone:918-367-3272
Mailing Address - Fax:918-367-5275
Practice Address - Street 1:700 W 7TH AVE
Practice Address - Street 2:STE 101
Practice Address - City:BRISTOW
Practice Address - State:OK
Practice Address - Zip Code:74010-2302
Practice Address - Country:US
Practice Address - Phone:918-367-3272
Practice Address - Fax:918-367-5275
Is Sole Proprietor?:No
Enumeration Date:2007-04-06
Last Update Date:2014-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK1622363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK200100700PMedicaid
OK200110220AMedicaid
OK24M712417Medicare PIN