Provider Demographics
NPI:1518915180
Name:DEEDS, LISA K (NP)
Entity Type:Individual
Prefix:
First Name:LISA
Middle Name:K
Last Name:DEEDS
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Gender:F
Credentials:NP
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Mailing Address - Street 1:1001 ROCK QUARRY RD
Mailing Address - Street 2:
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27610-3825
Mailing Address - Country:US
Mailing Address - Phone:919-833-3111
Mailing Address - Fax:919-834-3118
Practice Address - Street 1:185 REDWOOD AVE
Practice Address - Street 2:SUITE 102
Practice Address - City:PENNINGTON GAP
Practice Address - State:VA
Practice Address - Zip Code:24277-2599
Practice Address - Country:US
Practice Address - Phone:276-546-5310
Practice Address - Fax:276-546-3440
Is Sole Proprietor?:No
Enumeration Date:2006-05-05
Last Update Date:2019-05-13
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
VA0024165418363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
VAP35669Medicare UPIN