Provider Demographics
NPI:1477867158
Name:BURTON, LISA M (ARNP)
Entity Type:Individual
Prefix:MRS
First Name:LISA
Middle Name:M
Last Name:BURTON
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:214 BRANDYWOOD CT
Mailing Address - Street 2:
Mailing Address - City:BOWLING GREEN
Mailing Address - State:KY
Mailing Address - Zip Code:42101-3911
Mailing Address - Country:US
Mailing Address - Phone:270-842-0441
Mailing Address - Fax:
Practice Address - Street 1:350 PARK ST STE 206
Practice Address - Street 2:
Practice Address - City:BOWLING GREEN
Practice Address - State:KY
Practice Address - Zip Code:42101-1784
Practice Address - Country:US
Practice Address - Phone:270-746-0440
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-08-04
Last Update Date:2010-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY6135P363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner