Provider Demographics
NPI:1639937840
Name:COLVIN, LISA (CRNP/PMHNP)
Entity Type:Individual
Prefix:
First Name:LISA
Middle Name:
Last Name:COLVIN
Suffix:
Gender:F
Credentials:CRNP/PMHNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:26213 GOOD NEWS CHAPEL RD
Mailing Address - Street 2:
Mailing Address - City:DOZIER
Mailing Address - State:AL
Mailing Address - Zip Code:36028
Mailing Address - Country:US
Mailing Address - Phone:334-488-9885
Mailing Address - Fax:
Practice Address - Street 1:1672 COLUMBIA HWY
Practice Address - Street 2:
Practice Address - City:DOTHAN
Practice Address - State:AL
Practice Address - Zip Code:36303-5434
Practice Address - Country:US
Practice Address - Phone:800-951-4357
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-03-12
Last Update Date:2024-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL1-166269363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health