Provider Demographics
NPI:1285919753
Name:BOTCHLET, SARA (NP)
Entity type:Individual
Prefix:
First Name:SARA
Middle Name:
Last Name:BOTCHLET
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:16925 NE 23RD ST STE 103
Mailing Address - Street 2:
Mailing Address - City:CHOCTAW
Mailing Address - State:OK
Mailing Address - Zip Code:73020-8410
Mailing Address - Country:US
Mailing Address - Phone:405-620-0049
Mailing Address - Fax:405-281-5726
Practice Address - Street 1:16925 NE 23RD ST STE 103
Practice Address - Street 2:
Practice Address - City:CHOCTAW
Practice Address - State:OK
Practice Address - Zip Code:73020-8410
Practice Address - Country:US
Practice Address - Phone:405-620-0049
Practice Address - Fax:405-281-5726
Is Sole Proprietor?:No
Enumeration Date:2011-10-17
Last Update Date:2021-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK86177363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK375739ZKLWMedicare PIN