Provider Demographics
NPI:1649419466
Name:DYER, LISA J (DNP, APRN, FNP-BC)
Entity Type:Individual
Prefix:DR
First Name:LISA
Middle Name:J
Last Name:DYER
Suffix:
Gender:F
Credentials:DNP, APRN, FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:77 STONEBRIDGE BLVD
Mailing Address - Street 2:
Mailing Address - City:JACKSON
Mailing Address - State:TN
Mailing Address - Zip Code:38305-2165
Mailing Address - Country:US
Mailing Address - Phone:731-780-1986
Mailing Address - Fax:731-984-9939
Practice Address - Street 1:77 STONEBRIDGE BLVD
Practice Address - Street 2:
Practice Address - City:JACKSON
Practice Address - State:TN
Practice Address - Zip Code:38305-2165
Practice Address - Country:US
Practice Address - Phone:731-780-1986
Practice Address - Fax:731-984-9939
Is Sole Proprietor?:Yes
Enumeration Date:2009-02-18
Last Update Date:2014-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNRN0000067203163W00000X
TN13930163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse