Provider Demographics
NPI:1316559073
Name:KAILEY, LISA R (MSN, APRN, FNP-BC)
Entity Type:Individual
Prefix:
First Name:LISA
Middle Name:R
Last Name:KAILEY
Suffix:
Gender:F
Credentials:MSN, APRN, FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3400 E FERNAN HILL RD
Mailing Address - Street 2:
Mailing Address - City:COEUR D ALENE
Mailing Address - State:ID
Mailing Address - Zip Code:83814-7588
Mailing Address - Country:US
Mailing Address - Phone:208-819-2183
Mailing Address - Fax:
Practice Address - Street 1:3400 E FERNAN HILL RD
Practice Address - Street 2:
Practice Address - City:COEUR D ALENE
Practice Address - State:ID
Practice Address - Zip Code:83814-7588
Practice Address - Country:US
Practice Address - Phone:208-819-2183
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-08-23
Last Update Date:2021-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH071833623363LF0000X
MARN2337812363LF0000X
ID68388363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily