Provider Demographics
NPI:1598461196
Name:POGUE, LISA CHURCHWELL (FNP)
Entity Type:Individual
Prefix:
First Name:LISA
Middle Name:CHURCHWELL
Last Name:POGUE
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1114 W 7TH ST
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:TN
Mailing Address - Zip Code:38401-1810
Mailing Address - Country:US
Mailing Address - Phone:931-490-1125
Mailing Address - Fax:931-490-1129
Practice Address - Street 1:1114 W 7TH ST
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:TN
Practice Address - Zip Code:38401-1810
Practice Address - Country:US
Practice Address - Phone:931-490-1125
Practice Address - Fax:931-490-1129
Is Sole Proprietor?:No
Enumeration Date:2023-02-06
Last Update Date:2023-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN96014363LF0000X
TNXXXXXX363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily