Provider Demographics
NPI:1033419437
Name:LISINSKI, PATRICIA J (PA)
Entity Type:Individual
Prefix:
First Name:PATRICIA
Middle Name:J
Last Name:LISINSKI
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:PATRICIA
Other - Middle Name:J
Other - Last Name:KUYKENDALL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2510 SANDCREST BLVD
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:IN
Mailing Address - Zip Code:47203-3047
Mailing Address - Country:US
Mailing Address - Phone:812-348-1000
Mailing Address - Fax:812-418-0470
Practice Address - Street 1:2510 SANDCREST DRIVE
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:IN
Practice Address - Zip Code:47203
Practice Address - Country:US
Practice Address - Phone:812-348-1000
Practice Address - Fax:812-418-0470
Is Sole Proprietor?:No
Enumeration Date:2010-11-01
Last Update Date:2020-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN10001760A363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
VAVV0559AOtherMEDICARE PTAN
VAVV0559AOtherMEDICARE PTAN