Provider Demographics
NPI:1518672906
Name:WALTON, SARA LYNN (PA)
Entity Type:Individual
Prefix:
First Name:SARA
Middle Name:LYNN
Last Name:WALTON
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
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Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:13125 E 77TH PL N
Mailing Address - Street 2:
Mailing Address - City:OWASSO
Mailing Address - State:OK
Mailing Address - Zip Code:74055-7129
Mailing Address - Country:US
Mailing Address - Phone:405-761-2761
Mailing Address - Fax:
Practice Address - Street 1:1145 S UTICA AVE STE 365
Practice Address - Street 2:
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74104-4004
Practice Address - Country:US
Practice Address - Phone:918-728-3354
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-01-19
Last Update Date:2023-01-19
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
OK363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant