Provider Demographics
NPI:1366811028
Name:MENZ, SARAH KELLEEN (CNP)
Entity type:Individual
Prefix:
First Name:SARAH
Middle Name:KELLEEN
Last Name:MENZ
Suffix:
Gender:F
Credentials:CNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 659506
Mailing Address - Street 2:SECTION 4142
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78265-0929
Mailing Address - Country:US
Mailing Address - Phone:405-776-1465
Mailing Address - Fax:405-869-7779
Practice Address - Street 1:2005 PARKVIEW DR STE 2
Practice Address - Street 2:
Practice Address - City:EL RENO
Practice Address - State:OK
Practice Address - Zip Code:73036-2145
Practice Address - Country:US
Practice Address - Phone:405-776-1465
Practice Address - Fax:405-869-7779
Is Sole Proprietor?:No
Enumeration Date:2015-09-23
Last Update Date:2021-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK84662363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK942489OtherMEDICARE PTAN
OK200616610AMedicaid
OK449668YX3QOtherMEDICARE PTAN