Healthcare Provider Details

I. General information

NPI: 1972411718
Provider Name (Legal Business Name): LISA MATSON MD PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/01/2026
Last Update Date: 09/01/2026
Certification Date: 09/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1100 HOSPITAL CIR
KINGFISHER OK
73750-5001
US

IV. Provider business mailing address

1100 HOSPITAL CIR
KINGFISHER OK
73750-5001
US

V. Phone/Fax

Practice location:
  • Phone: 405-375-2350
  • Fax: 405-375-2368
Mailing address:
  • Phone: 405-375-2350
  • Fax: 405-375-2368

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: LISA S MATSON
Title or Position: OWNER
Credential: MD
Phone: 405-538-7811