Healthcare Provider Details

I. General information

NPI: 1023971553
Provider Name (Legal Business Name): DEESHA BROOKE LORNES FNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/03/2025
Last Update Date: 12/03/2025
Certification Date: 11/20/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12410 NE 28TH ST
CHOCTAW OK
73020-8604
US

IV. Provider business mailing address

12410 NE 28TH ST
CHOCTAW OK
73020-8604
US

V. Phone/Fax

Practice location:
  • Phone: 580-798-7620
  • Fax:
Mailing address:
  • Phone: 580-798-7620
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number226493
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: