Provider Demographics
NPI:1528067485
Name:HENDERSON, SARAH K (PA)
Entity type:Individual
Prefix:
First Name:SARAH
Middle Name:K
Last Name:HENDERSON
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:SARAH
Other - Middle Name:K
Other - Last Name:SHAFER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:5300 N INDEPENDENCE AVE
Mailing Address - Street 2:280
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73112-5556
Mailing Address - Country:US
Mailing Address - Phone:405-853-7171
Mailing Address - Fax:405-853-6662
Practice Address - Street 1:300 N CHEROKEE ST
Practice Address - Street 2:
Practice Address - City:HENNESSEY
Practice Address - State:OK
Practice Address - Zip Code:73742-1106
Practice Address - Country:US
Practice Address - Phone:405-853-7171
Practice Address - Fax:405-853-6662
Is Sole Proprietor?:No
Enumeration Date:2005-07-21
Last Update Date:2018-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OKPA1061363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK100108630BMedicaid
OK241426101Medicare PIN
P25479Medicare UPIN