Provider Demographics
NPI:1568766145
Name:HOOKER, LISA (CFNP)
Entity Type:Individual
Prefix:
First Name:LISA
Middle Name:
Last Name:HOOKER
Suffix:
Gender:F
Credentials:CFNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1013
Mailing Address - Street 2:
Mailing Address - City:OXFORD
Mailing Address - State:MS
Mailing Address - Zip Code:38655-1013
Mailing Address - Country:US
Mailing Address - Phone:662-234-1448
Mailing Address - Fax:662-234-5374
Practice Address - Street 1:2168 S LAMAR BLVD
Practice Address - Street 2:
Practice Address - City:OXFORD
Practice Address - State:MS
Practice Address - Zip Code:38655
Practice Address - Country:US
Practice Address - Phone:662-234-1448
Practice Address - Fax:662-234-5374
Is Sole Proprietor?:No
Enumeration Date:2010-12-22
Last Update Date:2023-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSR865030363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS09822395Medicaid
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