Provider Demographics
NPI:1659806669
Name:FORD, LISA
Entity Type:Individual
Prefix:
First Name:LISA
Middle Name:
Last Name:FORD
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 1:1601 W OKMULGEE ST STE M
Mailing Address - Street 2:
Mailing Address - City:MUSKOGEE
Mailing Address - State:OK
Mailing Address - Zip Code:74401-6700
Mailing Address - Country:US
Mailing Address - Phone:918-681-4944
Mailing Address - Fax:918-681-4990
Practice Address - Street 1:1601 W OKMULGEE ST STE M
Practice Address - Street 2:
Practice Address - City:MUSKOGEE
Practice Address - State:OK
Practice Address - Zip Code:74401-6700
Practice Address - Country:US
Practice Address - Phone:918-681-4944
Practice Address - Fax:918-681-4990
Is Sole Proprietor?:Yes
Enumeration Date:2017-04-27
Last Update Date:2017-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator