Provider Demographics
NPI:1821707696
Name:HEFNER, SARALYN DYER (PA-C)
Entity Type:Individual
Prefix:
First Name:SARALYN
Middle Name:DYER
Last Name:HEFNER
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:SARALYN
Other - Middle Name:Y
Other - Last Name:DYER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA-C
Mailing Address - Street 1:13401 N WESTERN AVE STE 404
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73114-1412
Mailing Address - Country:US
Mailing Address - Phone:405-608-4440
Mailing Address - Fax:405-607-3546
Practice Address - Street 1:13401 N WESTERN AVE STE 404
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73114-1412
Practice Address - Country:US
Practice Address - Phone:405-608-4440
Practice Address - Fax:405-607-3546
Is Sole Proprietor?:No
Enumeration Date:2022-11-21
Last Update Date:2023-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK4863363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant