Provider Demographics
NPI:1609842426
Name:MUIRHEAD, LISA A (APN)
Entity Type:Individual
Prefix:
First Name:LISA
Middle Name:A
Last Name:MUIRHEAD
Suffix:
Gender:F
Credentials:APN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1949 GUNBARREL RD
Mailing Address - Street 2:SUITE 125
Mailing Address - City:CHATTANOOGA
Mailing Address - State:TN
Mailing Address - Zip Code:37421-3188
Mailing Address - Country:US
Mailing Address - Phone:423-664-4635
Mailing Address - Fax:423-664-4640
Practice Address - Street 1:1949 GUNBARREL RD
Practice Address - Street 2:SUITE 125
Practice Address - City:CHATTANOOGA
Practice Address - State:TN
Practice Address - Zip Code:37421-3188
Practice Address - Country:US
Practice Address - Phone:423-664-4635
Practice Address - Fax:423-664-4640
Is Sole Proprietor?:No
Enumeration Date:2006-02-23
Last Update Date:2008-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN11764363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3642504Medicaid
TN3642504Medicare ID - Type Unspecified
TN3642504Medicaid