Provider Demographics
NPI:1861968364
Name:WOODWORTH, LISA GAY (APRN)
Entity type:Individual
Prefix:
First Name:LISA
Middle Name:GAY
Last Name:WOODWORTH
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:LISA
Other - Middle Name:GAY
Other - Last Name:DISHMAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1001 S 41ST ST E
Mailing Address - Street 2:
Mailing Address - City:MUSKOGEE
Mailing Address - State:OK
Mailing Address - Zip Code:74403-6253
Mailing Address - Country:US
Mailing Address - Phone:918-781-6542
Mailing Address - Fax:918-683-2922
Practice Address - Street 1:1001 S 41ST ST E
Practice Address - Street 2:
Practice Address - City:MUSKOGEE
Practice Address - State:OK
Practice Address - Zip Code:74403-6253
Practice Address - Country:US
Practice Address - Phone:918-781-6542
Practice Address - Fax:918-683-2922
Is Sole Proprietor?:No
Enumeration Date:2018-10-23
Last Update Date:2018-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK73781363LP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care