Provider Demographics
NPI:1649908930
Name:CLOSE, SARAH LYNN (APRN)
Entity type:Individual
Prefix:
First Name:SARAH
Middle Name:LYNN
Last Name:CLOSE
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:395200 W 2900 RD
Mailing Address - Street 2:
Mailing Address - City:OCHELATA
Mailing Address - State:OK
Mailing Address - Zip Code:74051-2463
Mailing Address - Country:US
Mailing Address - Phone:918-535-6000
Mailing Address - Fax:918-535-2367
Practice Address - Street 1:395090 W 2950 DR
Practice Address - Street 2:
Practice Address - City:OCHELATA
Practice Address - State:OK
Practice Address - Zip Code:74051-2500
Practice Address - Country:US
Practice Address - Phone:918-766-5879
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-08-12
Last Update Date:2023-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK209820363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK23154677OtherNCSBN ID