Healthcare Provider Details

I. General information

NPI: 1053528778
Provider Name (Legal Business Name): LISA J BOOKER APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/16/2007
Last Update Date: 07/01/2026
Certification Date: 07/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

700 W KEISER AVE
OSCEOLA AR
72370-3506
US

IV. Provider business mailing address

700 W KEISER AVE
OSCEOLA AR
72370-3506
US

V. Phone/Fax

Practice location:
  • Phone: 870-563-0757
  • Fax: 870-563-0752
Mailing address:
  • Phone: 870-563-0757
  • Fax: 870-563-0752

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberA001659
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: