Healthcare Provider Details

I. General information

NPI: 1629766407
Provider Name (Legal Business Name): MUSKOGEE FAMILY PRACTICE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/28/2023
Last Update Date: 12/04/2025
Certification Date: 12/04/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1118 W BROADWAY ST
MUSKOGEE OK
74401-6246
US

IV. Provider business mailing address

1118 W BROADWAY ST
MUSKOGEE OK
74401-6246
US

V. Phone/Fax

Practice location:
  • Phone: 918-681-7554
  • Fax:
Mailing address:
  • Phone: 918-681-7554
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number
License Number State

VIII. Authorized Official

Name: LISA S BRISCOE
Title or Position: MANAGER
Credential: CPC, CPB, CRC
Phone: 918-808-7626