Provider Demographics
NPI:1154883353
Name:DAVIS, LISA KAYE (APRN, FNP-C)
Entity type:Individual
Prefix:MS
First Name:LISA
Middle Name:KAYE
Last Name:DAVIS
Suffix:
Gender:F
Credentials:APRN, FNP-C
Other - Prefix:MRS
Other - First Name:LISA
Other - Middle Name:KAYE
Other - Last Name:DAVIS-SAMPERT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:APRN, FNP-C
Mailing Address - Street 1:1203 N WASHINGTON AVENUE #1048
Mailing Address - Street 2:
Mailing Address - City:DURANT
Mailing Address - State:OK
Mailing Address - Zip Code:74701
Mailing Address - Country:US
Mailing Address - Phone:580-380-7372
Mailing Address - Fax:
Practice Address - Street 1:2510 CHICKASAW BLVD
Practice Address - Street 2:
Practice Address - City:ARDMORE
Practice Address - State:OK
Practice Address - Zip Code:73401-1341
Practice Address - Country:US
Practice Address - Phone:580-226-8181
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-04-05
Last Update Date:2025-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAP140978363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily