Provider Demographics
NPI:1275148850
Name:MCKEVER, LISA SHINTAL
Entity Type:Individual
Prefix:
First Name:LISA
Middle Name:SHINTAL
Last Name:MCKEVER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:LISA
Other - Middle Name:SHINTAL
Other - Last Name:MCKEVER
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:ALF ADMINISTRATOR
Mailing Address - Street 1:29 VALLEYFIELD DR
Mailing Address - Street 2:
Mailing Address - City:CLAYTON
Mailing Address - State:NC
Mailing Address - Zip Code:27527-4238
Mailing Address - Country:US
Mailing Address - Phone:910-635-0295
Mailing Address - Fax:
Practice Address - Street 1:204 N 4TH ST
Practice Address - Street 2:
Practice Address - City:SMITHFIELD
Practice Address - State:NC
Practice Address - Zip Code:27577-3932
Practice Address - Country:US
Practice Address - Phone:910-635-0295
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-09-10
Last Update Date:2020-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCA00002710376G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376G00000XNursing Service Related ProvidersNursing Home Administrator