Provider Demographics
NPI:1851016208
Name:MAHAFFEY-PICKUP, SARAH RENEA
Entity Type:Individual
Prefix:
First Name:SARAH
Middle Name:RENEA
Last Name:MAHAFFEY-PICKUP
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:407 W SOUTH AVE
Mailing Address - Street 2:
Mailing Address - City:PONCA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:74601-6133
Mailing Address - Country:US
Mailing Address - Phone:580-235-9990
Mailing Address - Fax:
Practice Address - Street 1:407 W S AVE, PONCA CITY, OK 74601
Practice Address - Street 2:
Practice Address - City:PONCA CITY
Practice Address - State:OK
Practice Address - Zip Code:74601
Practice Address - Country:US
Practice Address - Phone:580-304-9972
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-10-07
Last Update Date:2022-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator