Provider Demographics
NPI:1629677745
Name:COLEMAN, LISA ELAINE (FNP-C, APRN)
Entity Type:Individual
Prefix:
First Name:LISA
Middle Name:ELAINE
Last Name:COLEMAN
Suffix:
Gender:F
Credentials:FNP-C, APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:101 W SHOWALTER DR
Mailing Address - Street 2:
Mailing Address - City:GEORGETOWN
Mailing Address - State:KY
Mailing Address - Zip Code:40324-2081
Mailing Address - Country:US
Mailing Address - Phone:502-868-6101
Mailing Address - Fax:
Practice Address - Street 1:2195 HARRODSBURG RD FL 2
Practice Address - Street 2:
Practice Address - City:LEXINGTON
Practice Address - State:KY
Practice Address - Zip Code:40504-3516
Practice Address - Country:US
Practice Address - Phone:859-562-1868
Practice Address - Fax:859-257-0421
Is Sole Proprietor?:No
Enumeration Date:2020-10-20
Last Update Date:2022-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY3014651363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily