Provider Demographics
NPI:1144212754
Name:COLTRANE, LISA YANCEY (MSN, RNCS, FNP)
Entity Type:Individual
Prefix:
First Name:LISA
Middle Name:YANCEY
Last Name:COLTRANE
Suffix:
Gender:F
Credentials:MSN, RNCS, FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:900 TRADE ST
Mailing Address - Street 2:
Mailing Address - City:TARBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27886-3855
Mailing Address - Country:US
Mailing Address - Phone:252-823-0718
Mailing Address - Fax:
Practice Address - Street 1:1473 NC HWY 42-43 W
Practice Address - Street 2:
Practice Address - City:PINETOPS
Practice Address - State:NC
Practice Address - Zip Code:27864-7188
Practice Address - Country:US
Practice Address - Phone:252-827-5231
Practice Address - Fax:252-827-5775
Is Sole Proprietor?:No
Enumeration Date:2005-08-19
Last Update Date:2021-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC200906363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
S43546Medicare UPIN
NC2594790AMedicare ID - Type Unspecified