Lisa Yvette Henderson, APRN
Individual provider Active NPI Nurse Practitioner · Cushing, OK
NPI 1912424243 · NPPES record last updated Sep 30, 2025
Key facts
- NPI
- 1912424243
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Nurse Practitioner 363L00000X
- License
- 118316 (OK)
- Practice address
- 601 E Broadway St
Cushing, OK 74023-3432 - Phone
- (316) 308-5768
- NPI assigned
- Aug 28, 2017
- Sex
- Female
- Sole proprietor
- No
Organizations & group practices 3
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in OK
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: Yes · Hospice: No
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20190610002285 | OK | Practitioner - Nurse Practitioner | 2163755927 | Reassigns benefits to 2 organizations |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Nurse Practitioner
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 118316 | OK | MD | Adult Health Nurse Practitioner |
| 53-77543-021 | KS | MD | Gerontology Nurse Practitioner |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Fairfax Medical Facilities Inc | Current |
Accepting new patients | |
| Fairfax Medical Facilities, Inc. | Current |
Accepting new patients | |
| NR Stillwater LLC | Current |
Accepting new patients |
Locations
212 N Main St
Fairfax, OK 74637
Phone (918) 642-3100
716 S Highway 77
Newkirk, OK 74647
Phone (580) 362-2555
3705 NW 63rd St
Ste 101
Oklahoma City, OK 73116
Phone (405) 286-9903
1411 W 12th Ave
Ste D
Stillwater, OK 74074
Phone (405) 724-6902
Interoperability endpoints
- https://fhir4.healow.com/fhir/r4/AGHIAA
- ms_lhende57@landmarkhealth-direct.org
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Gerontology Nurse Practitioner | 363LG0600X | 53-77543-021 | KS | |
| Nurse Practitioner | 363L00000X | 118316 | OK | Yes |
| Adult Health Nurse Practitioner | 363LA2200X | 118316 | OK | |
| Adult Health Nurse Practitioner | 363LA2200X | 53-77543-021 | KS |
Addresses
Primary practice location
601 E Broadway St
Cushing, OK 74023-3432
Mailing address
601 E Broadway St
Cushing, OK 74023-3432
Phone (316) 308-5768
Other providers in Cushing, OK
- Christie M Hamner
- Sarah Hanna
- Aushia Renea Harrison
- Candice Leigh Hart
- Chris Dale Hawthorn
- Hightower & Grellner
- Hightower & Grellner LLC
- Robert Brian Hightower
- Ladawna Shawndrae Hollingshad
- Laneta D Houston
All providers in Cushing, OK · Nurse Practitioner in Oklahoma
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Sep 30, 2025. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.