Provider Demographics
NPI:1609371392
Name:WATSON, SANDRA SCOTT (FNP-C, APRN)
Entity Type:Individual
Prefix:
First Name:SANDRA
Middle Name:SCOTT
Last Name:WATSON
Suffix:
Gender:F
Credentials:FNP-C, APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:6465 S YALE AVE STE 401
Mailing Address - Street 2:
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74136-7806
Mailing Address - Country:US
Mailing Address - Phone:918-582-3154
Mailing Address - Fax:981-582-3593
Practice Address - Street 1:591 E 36TH ST N
Practice Address - Street 2:
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74106-1812
Practice Address - Country:US
Practice Address - Phone:918-619-4400
Practice Address - Fax:918-619-4591
Is Sole Proprietor?:No
Enumeration Date:2018-03-26
Last Update Date:2021-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK0071733363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK200765020AMedicaid