Provider Demographics
NPI:1033479555
Name:CARNEY, LISA MARIE (CRNA)
Entity Type:Individual
Prefix:
First Name:LISA
Middle Name:MARIE
Last Name:CARNEY
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:
Other - First Name:LISA
Other - Middle Name:MARIE
Other - Last Name:PAYNE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CRNA
Mailing Address - Street 1:PO BOX 2897
Mailing Address - Street 2:
Mailing Address - City:WICHITA
Mailing Address - State:KS
Mailing Address - Zip Code:67201-2897
Mailing Address - Country:US
Mailing Address - Phone:844-468-9498
Mailing Address - Fax:855-630-1302
Practice Address - Street 1:929 N SAINT FRANCIS ST
Practice Address - Street 2:
Practice Address - City:WICHITA
Practice Address - State:KS
Practice Address - Zip Code:67214
Practice Address - Country:US
Practice Address - Phone:844-468-9498
Practice Address - Fax:855-630-1302
Is Sole Proprietor?:No
Enumeration Date:2012-05-17
Last Update Date:2022-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COAPN.0990778-CRNA367500000X
KS557116367500000X, 367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO17755549Medicaid
COP01509061OtherRR MEDICARE
KSP01961789OtherRR MEDICARE
KS200965660BMedicaid