Provider Demographics
NPI:1609273002
Name:GRIFFIN, LISA (APRN)
Entity Type:Individual
Prefix:
First Name:LISA
Middle Name:
Last Name:GRIFFIN
Suffix:
Gender:F
Credentials:APRN
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 93335
Mailing Address - Street 2:
Mailing Address - City:LAFAYETTE
Mailing Address - State:LA
Mailing Address - Zip Code:70509-3335
Mailing Address - Country:US
Mailing Address - Phone:337-345-5644
Mailing Address - Fax:337-703-4329
Practice Address - Street 1:1009 CHARITY ST
Practice Address - Street 2:
Practice Address - City:ABBEVILLE
Practice Address - State:LA
Practice Address - Zip Code:70510-5302
Practice Address - Country:US
Practice Address - Phone:337-893-3443
Practice Address - Fax:337-893-3439
Is Sole Proprietor?:Yes
Enumeration Date:2014-12-01
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LATAP003245363LP0808X
LAAP08077363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA2382497Medicaid
LAMG3488207OtherDEA