Provider Demographics
NPI:1114486396
Name:HUNERYAGER, LYSHA
Entity Type:Individual
Prefix:
First Name:LYSHA
Middle Name:
Last Name:HUNERYAGER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8523 E 11TH ST STE A
Mailing Address - Street 2:
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74112-7963
Mailing Address - Country:US
Mailing Address - Phone:918-609-1600
Mailing Address - Fax:
Practice Address - Street 1:8523 E 11TH ST STE A
Practice Address - Street 2:
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74112-7963
Practice Address - Country:US
Practice Address - Phone:918-609-1600
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-03-18
Last Update Date:2019-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK0105988363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily