Provider Demographics
NPI:1417983388
Name:COLLINS, LISA M (CNM)
Entity Type:Individual
Prefix:
First Name:LISA
Middle Name:M
Last Name:COLLINS
Suffix:
Gender:F
Credentials:CNM
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:803 MEYERS BAKER RD
Mailing Address - Street 2:STE 200
Mailing Address - City:LONDON
Mailing Address - State:KY
Mailing Address - Zip Code:40741-3039
Mailing Address - Country:US
Mailing Address - Phone:606-878-3240
Mailing Address - Fax:606-878-4308
Practice Address - Street 1:803 MEYERS BAKER RD
Practice Address - Street 2:STE 200
Practice Address - City:LONDON
Practice Address - State:KY
Practice Address - Zip Code:40741-3039
Practice Address - Country:US
Practice Address - Phone:606-878-3240
Practice Address - Fax:606-878-4308
Is Sole Proprietor?:No
Enumeration Date:2006-06-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
KY1856M367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY78000890Medicaid
KY0903207Medicare ID - Type Unspecified
KY78000890Medicaid