Provider Demographics
NPI:1326042383
Name:KAPPES, LISA A (FNP)
Entity Type:Individual
Prefix:
First Name:LISA
Middle Name:A
Last Name:KAPPES
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:LISA
Other - Middle Name:A
Other - Last Name:TURK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 14890
Mailing Address - Street 2:
Mailing Address - City:ALBANY
Mailing Address - State:NY
Mailing Address - Zip Code:12212-4890
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1 PINE WEST PLZ STE 101
Practice Address - Street 2:
Practice Address - City:ALBANY
Practice Address - State:NY
Practice Address - Zip Code:12205-5531
Practice Address - Country:US
Practice Address - Phone:518-464-9999
Practice Address - Fax:518-464-9650
Is Sole Proprietor?:No
Enumeration Date:2005-06-08
Last Update Date:2022-11-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYF331790-1363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYRB5183Medicare PIN
CC4257Medicare ID - Type Unspecified
P23672Medicare UPIN
NYRB5184Medicare PIN