Provider Demographics
NPI:1104896760
Name:WEST, LISA DANETTE (PA-C)
Entity type:Individual
Prefix:MS
First Name:LISA
Middle Name:DANETTE
Last Name:WEST
Suffix:
Gender:F
Credentials:PA-C
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Mailing Address - Street 1:3555 NW 58TH ST
Mailing Address - Street 2:SUITE 900
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73112-4707
Mailing Address - Country:US
Mailing Address - Phone:405-917-0418
Mailing Address - Fax:405-917-0419
Practice Address - Street 1:520 S TELEPHONE RD
Practice Address - Street 2:
Practice Address - City:MOORE
Practice Address - State:OK
Practice Address - Zip Code:73160-5423
Practice Address - Country:US
Practice Address - Phone:405-793-9355
Practice Address - Fax:405-793-1621
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-01-25
Last Update Date:2007-07-08
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
OK1163363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
OKP73864Medicare UPIN