Provider Demographics
NPI:1164730883
Name:HEARN, LISA (RN)
Entity Type:Individual
Prefix:MRS
First Name:LISA
Middle Name:
Last Name:HEARN
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1916 PAMELA LN
Mailing Address - Street 2:
Mailing Address - City:WEATHERFORD
Mailing Address - State:OK
Mailing Address - Zip Code:73096-2333
Mailing Address - Country:US
Mailing Address - Phone:580-774-8539
Mailing Address - Fax:
Practice Address - Street 1:1916 PAMELA LN
Practice Address - Street 2:
Practice Address - City:WEATHERFORD
Practice Address - State:OK
Practice Address - Zip Code:73096-2333
Practice Address - Country:US
Practice Address - Phone:580-774-8539
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-09-15
Last Update Date:2010-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health