Provider Demographics
NPI:1902629728
Name:BOATNER, SEAN MCKINLEY SR
Entity type:Individual
Prefix:MR
First Name:SEAN
Middle Name:MCKINLEY
Last Name:BOATNER
Suffix:SR
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2301 NW 195TH ST
Mailing Address - Street 2:
Mailing Address - City:EDMOND
Mailing Address - State:OK
Mailing Address - Zip Code:73012-3523
Mailing Address - Country:US
Mailing Address - Phone:832-788-8956
Mailing Address - Fax:
Practice Address - Street 1:2609 CHATEAU DR
Practice Address - Street 2:
Practice Address - City:NORMAN
Practice Address - State:OK
Practice Address - Zip Code:73069-5016
Practice Address - Country:US
Practice Address - Phone:405-701-6656
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-11-01
Last Update Date:2024-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator