Provider Demographics
NPI:1326392895
Name:FETTER, LISA J (APRN-BC)
Entity Type:Individual
Prefix:MS
First Name:LISA
Middle Name:J
Last Name:FETTER
Suffix:
Gender:F
Credentials:APRN-BC
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:6413 BARDSTOWN RD
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40291
Mailing Address - Country:US
Mailing Address - Phone:502-638-4906
Mailing Address - Fax:502-231-0220
Practice Address - Street 1:6413 BARDSTOWN RD
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40291
Practice Address - Country:US
Practice Address - Phone:502-638-4906
Practice Address - Fax:502-231-0220
Is Sole Proprietor?:No
Enumeration Date:2012-11-05
Last Update Date:2015-06-04
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
KY3007846363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily