Provider Demographics
NPI:1528363827
Name:ENYART, SARA JEAN (PA-C)
Entity Type:Individual
Prefix:
First Name:SARA
Middle Name:JEAN
Last Name:ENYART
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:SARA
Other - Middle Name:
Other - Last Name:UPDIKE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:10512 N 110TH EAST AVE
Mailing Address - Street 2:STE 100
Mailing Address - City:OWASSO
Mailing Address - State:OK
Mailing Address - Zip Code:74055-6638
Mailing Address - Country:US
Mailing Address - Phone:918-376-8410
Mailing Address - Fax:918-376-8839
Practice Address - Street 1:10512 N 110TH EAST AVE
Practice Address - Street 2:STE 100
Practice Address - City:OWASSO
Practice Address - State:OK
Practice Address - Zip Code:74055-6638
Practice Address - Country:US
Practice Address - Phone:918-376-8149
Practice Address - Fax:918-376-8410
Is Sole Proprietor?:No
Enumeration Date:2011-01-18
Last Update Date:2016-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK1993363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK200319280AMedicaid
OK407358YLV0Medicare PIN