Provider Demographics
NPI:1437191434
Name:PAINTER, LISA WHITNEY (NP-C)
Entity Type:Individual
Prefix:
First Name:LISA
Middle Name:WHITNEY
Last Name:PAINTER
Suffix:
Gender:F
Credentials:NP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1021 W OAKLAND AVE STE 310
Mailing Address - Street 2:
Mailing Address - City:JOHNSON CITY
Mailing Address - State:TN
Mailing Address - Zip Code:37604-2192
Mailing Address - Country:US
Mailing Address - Phone:423-302-6565
Mailing Address - Fax:
Practice Address - Street 1:671 HIGHWAY 58 E
Practice Address - Street 2:
Practice Address - City:NORTON
Practice Address - State:VA
Practice Address - Zip Code:24273-3007
Practice Address - Country:US
Practice Address - Phone:276-679-5874
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-06-12
Last Update Date:2023-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX506604363L00000X
TXAP108704363L00000X
VA0024186434363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX155695302Medicaid
TX157895704Medicaid
TX155695301Medicaid
TX155695303Medicaid
TX155695304Medicaid
TXS65526Medicare UPIN
TX155695304Medicaid
TX8D5727Medicare PIN
TX500027094Medicare PIN
TX270798Medicare PIN
TX360999YN56Medicare PIN
TX8D5732Medicare PIN