Provider Demographics
NPI:1023002631
Name:HUNT, LISA CASTELLAW (FNP APN)
Entity Type:Individual
Prefix:
First Name:LISA
Middle Name:CASTELLAW
Last Name:HUNT
Suffix:
Gender:F
Credentials:FNP APN
Other - Prefix:
Other - First Name:LISA
Other - Middle Name:
Other - Last Name:CASTELLAW
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:FNP APN
Mailing Address - Street 1:1700 WOODLAWN AVE
Mailing Address - Street 2:
Mailing Address - City:DYERSBURG
Mailing Address - State:TN
Mailing Address - Zip Code:38024-2028
Mailing Address - Country:US
Mailing Address - Phone:731-287-4500
Mailing Address - Fax:731-287-4804
Practice Address - Street 1:624 NORA DRIVE
Practice Address - Street 2:
Practice Address - City:NEWBERN
Practice Address - State:TN
Practice Address - Zip Code:38059
Practice Address - Country:US
Practice Address - Phone:731-627-9560
Practice Address - Fax:731-627-9518
Is Sole Proprietor?:No
Enumeration Date:2005-09-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNRN83686363L00000X
TNAPN6424363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
3101540OtherBLUE CROSS
8857OtherTLC MEMPHIS MANAGED CARE
116244OtherBETTER HEALTH PLAN
TN3345045Medicaid
TN3101540OtherBL CROSS
S54504Medicare UPIN
116244OtherBETTER HEALTH PLAN