Provider Demographics
NPI:1023318185
Name:DAVIS, LISA DARCELL (APRN-CNS)
Entity type:Individual
Prefix:
First Name:LISA
Middle Name:DARCELL
Last Name:DAVIS
Suffix:
Gender:F
Credentials:APRN-CNS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6161 S YALE AVE
Mailing Address - Street 2:SUITE A100
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74136-1902
Mailing Address - Country:US
Mailing Address - Phone:918-494-8500
Mailing Address - Fax:918-307-5578
Practice Address - Street 1:6161 S YALE AVE
Practice Address - Street 2:SUITE A100
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74136-1902
Practice Address - Country:US
Practice Address - Phone:918-494-8500
Practice Address - Fax:918-307-5578
Is Sole Proprietor?:No
Enumeration Date:2010-10-23
Last Update Date:2012-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OKR0053496364SC0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes364SC0200XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistCritical Care Medicine