Provider Demographics
NPI:1083135255
Name:COX, LISA (LPN)
Entity Type:Individual
Prefix:
First Name:LISA
Middle Name:
Last Name:COX
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:110 E TUMBLEWEED LN
Mailing Address - Street 2:
Mailing Address - City:DAVIS
Mailing Address - State:OK
Mailing Address - Zip Code:73030-9607
Mailing Address - Country:US
Mailing Address - Phone:580-247-5192
Mailing Address - Fax:
Practice Address - Street 1:921 W 11TH ST STE 2
Practice Address - Street 2:
Practice Address - City:SULPHUR
Practice Address - State:OK
Practice Address - Zip Code:73086-4459
Practice Address - Country:US
Practice Address - Phone:580-622-2353
Practice Address - Fax:580-622-2351
Is Sole Proprietor?:Yes
Enumeration Date:2017-06-28
Last Update Date:2018-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK1699138149207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine