Provider Demographics
NPI:1053721142
Name:CLOUGHLY, SARAH (PA-C)
Entity type:Individual
Prefix:
First Name:SARAH
Middle Name:
Last Name:CLOUGHLY
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7807 S WALKER AVE
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73139-9470
Mailing Address - Country:US
Mailing Address - Phone:405-636-0767
Mailing Address - Fax:405-636-0353
Practice Address - Street 1:7807 S WALKER AVE
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73139-9470
Practice Address - Country:US
Practice Address - Phone:405-636-0767
Practice Address - Fax:405-636-0353
Is Sole Proprietor?:No
Enumeration Date:2014-04-29
Last Update Date:2020-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA51534363A00000X
OK2517363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant