Provider Demographics
NPI:1609466473
Name:SPEER, LISA JEANETTE (APRN)
Entity Type:Individual
Prefix:
First Name:LISA
Middle Name:JEANETTE
Last Name:SPEER
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 1:2180 ADA AVE STE 300
Mailing Address - Street 2:
Mailing Address - City:CONWAY
Mailing Address - State:AR
Mailing Address - Zip Code:72034-4300
Mailing Address - Country:US
Mailing Address - Phone:501-327-6547
Mailing Address - Fax:501-327-9715
Practice Address - Street 1:2180 ADA AVE STE 300
Practice Address - Street 2:
Practice Address - City:CONWAY
Practice Address - State:AR
Practice Address - Zip Code:72034-4300
Practice Address - Country:US
Practice Address - Phone:501-327-6547
Practice Address - Fax:501-327-9715
Is Sole Proprietor?:No
Enumeration Date:2021-01-25
Last Update Date:2023-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR214656363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR261975758Medicaid