Provider Demographics
NPI:1508593369
Name:WEEAMS, LISA MCKINNEY (CRC, LPN, CCM)
Entity Type:Individual
Prefix:MS
First Name:LISA
Middle Name:MCKINNEY
Last Name:WEEAMS
Suffix:
Gender:F
Credentials:CRC, LPN, CCM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2502 ALLEN RD
Mailing Address - Street 2:
Mailing Address - City:WILLISTON
Mailing Address - State:TN
Mailing Address - Zip Code:38076-3006
Mailing Address - Country:US
Mailing Address - Phone:901-409-9801
Mailing Address - Fax:
Practice Address - Street 1:2502 ALLEN RD
Practice Address - Street 2:
Practice Address - City:WILLISTON
Practice Address - State:TN
Practice Address - Zip Code:38076-3006
Practice Address - Country:US
Practice Address - Phone:901-409-9801
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-08-02
Last Update Date:2022-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL183488225C00000X
TN040409164W00000X
TX335398164X00000X
NJ4230652171M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225C00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRehabilitation Counselor
No164W00000XNursing Service ProvidersLicensed Practical Nurse
No164X00000XNursing Service ProvidersLicensed Vocational Nurse
No171M00000XOther Service ProvidersCase Manager/Care Coordinator