Provider Demographics
NPI:1326361668
Name:BARACKER, LISA A (DO)
Entity type:Individual
Prefix:DR
First Name:LISA
Middle Name:A
Last Name:BARACKER
Suffix:
Gender:F
Credentials:DO
Other - Prefix:MS
Other - First Name:LISA
Other - Middle Name:D
Other - Last Name:AGEE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2809 NE LINCOLN RD
Mailing Address - Street 2:
Mailing Address - City:IDABEL
Mailing Address - State:OK
Mailing Address - Zip Code:74745-2421
Mailing Address - Country:US
Mailing Address - Phone:580-286-6688
Mailing Address - Fax:580-286-6699
Practice Address - Street 1:2809 NE LINCOLN RD
Practice Address - Street 2:
Practice Address - City:IDABEL
Practice Address - State:OK
Practice Address - Zip Code:74745-2421
Practice Address - Country:US
Practice Address - Phone:580-286-6688
Practice Address - Fax:580-286-6699
Is Sole Proprietor?:No
Enumeration Date:2010-03-01
Last Update Date:2025-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORDO220145207Q00000X
OK5180207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine