Provider Demographics
NPI:1053515064
Name:WARD, LISA PHILLIPS (APN)
Entity type:Individual
Prefix:
First Name:LISA
Middle Name:PHILLIPS
Last Name:WARD
Suffix:
Gender:F
Credentials:APN
Other - Prefix:
Other - First Name:LISA
Other - Middle Name:P
Other - Last Name:WILLIAMS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:18 N. CAVALIER DR.
Mailing Address - Street 2:
Mailing Address - City:ALAMO
Mailing Address - State:TN
Mailing Address - Zip Code:38001
Mailing Address - Country:US
Mailing Address - Phone:731-696-4500
Mailing Address - Fax:731-696-2152
Practice Address - Street 1:18 N CAVALIER DR
Practice Address - Street 2:
Practice Address - City:ALAMO
Practice Address - State:TN
Practice Address - Zip Code:38001-6468
Practice Address - Country:US
Practice Address - Phone:731-696-4500
Practice Address - Fax:731-696-2152
Is Sole Proprietor?:No
Enumeration Date:2007-06-13
Last Update Date:2020-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNAPN7204363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN1510858Medicaid
3342313Medicare PIN