Provider Demographics
NPI:1346753456
Name:MCCONNELL, LISA MICHELLE (APRN-CNP, FNP-C)
Entity type:Individual
Prefix:
First Name:LISA
Middle Name:MICHELLE
Last Name:MCCONNELL
Suffix:
Gender:F
Credentials:APRN-CNP, FNP-C
Other - Prefix:
Other - First Name:LISA
Other - Middle Name:MICHELLE
Other - Last Name:PATISON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2212 N BROADWAY ST
Mailing Address - Street 2:
Mailing Address - City:MOORE
Mailing Address - State:OK
Mailing Address - Zip Code:73160-4303
Mailing Address - Country:US
Mailing Address - Phone:405-285-7222
Mailing Address - Fax:405-285-7227
Practice Address - Street 1:2212 N BROADWAY ST
Practice Address - Street 2:
Practice Address - City:MOORE
Practice Address - State:OK
Practice Address - Zip Code:73160-4303
Practice Address - Country:US
Practice Address - Phone:405-285-7222
Practice Address - Fax:405-285-7227
Is Sole Proprietor?:No
Enumeration Date:2017-11-10
Last Update Date:2025-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK109623363L00000X, 363LF0000X, 363LP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK200797220AMedicaid
14209973OtherCAQH