Provider Demographics
NPI:1457679367
Name:WHITTEN, LISA R
Entity Type:Individual
Prefix:MRS
First Name:LISA
Middle Name:R
Last Name:WHITTEN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:902 S HIGH ST
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:TN
Mailing Address - Zip Code:38401-3204
Mailing Address - Country:US
Mailing Address - Phone:931-490-6510
Mailing Address - Fax:931-381-0945
Practice Address - Street 1:902 S HIGH ST
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:TN
Practice Address - Zip Code:38401-3204
Practice Address - Country:US
Practice Address - Phone:931-490-6510
Practice Address - Fax:931-381-0945
Is Sole Proprietor?:Yes
Enumeration Date:2010-05-17
Last Update Date:2010-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator