Individual
LISA MICHELLE MCCONNELL
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
APRN-CNP, FNP-C
Contact information
Practice address
2212 N BROADWAY ST, MOORE, OK 73160-4303
(405) 285-7222
(405) 285-7227
Mailing address
2212 N BROADWAY ST, MOORE, OK 73160-4303
(405) 285-7222
(405) 285-7227
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
109623
OK
363LF0000X
Family Nurse Practitioner
Primary
109623
OK
363LP2300X
Primary Care Nurse Practitioner
109623
OK
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
14209973
CAQH
—
05
—
200797220A
—
OK
Enumeration date
11/10/2017
Last updated
12/05/2025
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