Individual
LISA BARRON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
1212 REYNOLDS AVE, POTEAU, OK 74953-4724
(918) 649-0172
Mailing address
1212 REYNOLDS AVE, POTEAU, OK 74953-4724
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
Primary
100394
OK
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
000000000
—
OK
Enumeration date
11/20/2018
Last updated
11/20/2018
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