Provider Demographics
NPI:1821544578
Name:MALONE, LISA (ADS/RCR)
Entity Type:Individual
Prefix:
First Name:LISA
Middle Name:
Last Name:MALONE
Suffix:
Gender:F
Credentials:ADS/RCR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 462
Mailing Address - Street 2:
Mailing Address - City:HENDERSONVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37077-0462
Mailing Address - Country:US
Mailing Address - Phone:615-714-1025
Mailing Address - Fax:
Practice Address - Street 1:1615 HORTON AVE
Practice Address - Street 2:
Practice Address - City:NASHVILLE
Practice Address - State:TN
Practice Address - Zip Code:37212
Practice Address - Country:US
Practice Address - Phone:615-714-1025
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-08-31
Last Update Date:2016-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNACU0000000262171100000X
TNRCR0000000023173C00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes173C00000XOther Service ProvidersReflexologist
No171100000XOther Service ProvidersAcupuncturist