Provider Demographics
NPI:1730116823
Name:AREHART, LISA (APRN)
Entity Type:Individual
Prefix:
First Name:LISA
Middle Name:
Last Name:AREHART
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 1:5032 LOCH DR
Mailing Address - Street 2:
Mailing Address - City:UNION
Mailing Address - State:KY
Mailing Address - Zip Code:41091-1485
Mailing Address - Country:US
Mailing Address - Phone:859-840-3627
Mailing Address - Fax:
Practice Address - Street 1:5032 LOCH DR
Practice Address - Street 2:
Practice Address - City:UNION
Practice Address - State:KY
Practice Address - Zip Code:41091-1485
Practice Address - Country:US
Practice Address - Phone:859-840-3627
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-06-26
Last Update Date:2020-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY3002712363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
000000323896OtherANTHEM
KYP00922877OtherRAIL ROAD MEDICARE
KY78003381Medicaid
IN201127120Medicaid
OH2466362Medicaid
500025962OtherRAILROAD MEDICARE
S67279Medicare UPIN
KY78003381Medicaid
500025962OtherRAILROAD MEDICARE
KY399013Medicare PIN