Provider Demographics
NPI:1790788420
Name:SPILLMAN, LISA L (NP)
Entity Type:Individual
Prefix:MRS
First Name:LISA
Middle Name:L
Last Name:SPILLMAN
Suffix:
Gender:F
Credentials:NP
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Mailing Address - Street 1:2605 KENUTCKY AVE
Mailing Address - Street 2:SUITE 3 BLDG 3
Mailing Address - City:PADUCAH
Mailing Address - State:KY
Mailing Address - Zip Code:42003-3804
Mailing Address - Country:US
Mailing Address - Phone:270-443-7534
Mailing Address - Fax:270-442-0309
Practice Address - Street 1:2605 KENUTCKY AVE
Practice Address - Street 2:SUITE 3 BLDG 3
Practice Address - City:PADUCAH
Practice Address - State:KY
Practice Address - Zip Code:42003
Practice Address - Country:US
Practice Address - Phone:270-443-7534
Practice Address - Fax:270-442-0309
Is Sole Proprietor?:No
Enumeration Date:2005-05-26
Last Update Date:2020-12-03
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
KY3002247363LF0000X, 363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY78001369Medicaid
S83567Medicare UPIN