Healthcare Provider Details

I. General information

NPI: 1992255186
Provider Name (Legal Business Name): LISA DOWNS APRN-CNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/11/2016
Last Update Date: 09/16/2024
Certification Date: 09/16/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3811 W GORE BLVD STE 6
LAWTON OK
73505-6328
US

IV. Provider business mailing address

275 BECK AVE # MS 32-200
FAIRFIELD CA
94533-6804
US

V. Phone/Fax

Practice location:
  • Phone: 580-250-6525
  • Fax: 580-354-5930
Mailing address:
  • Phone: 707-784-8600
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberR0048821
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: