Provider Demographics
NPI:1851726681
Name:ADAMS, LISA KAY (MPAS, PA)
Entity Type:Individual
Prefix:
First Name:LISA
Middle Name:KAY
Last Name:ADAMS
Suffix:
Gender:F
Credentials:MPAS, PA
Other - Prefix:
Other - First Name:LISA
Other - Middle Name:KAY
Other - Last Name:DAVES
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MS
Mailing Address - Street 1:3288 MOANALUA RD
Mailing Address - Street 2:
Mailing Address - City:HONOLULU
Mailing Address - State:HI
Mailing Address - Zip Code:96819-1469
Mailing Address - Country:US
Mailing Address - Phone:808-432-8000
Mailing Address - Fax:808-432-8590
Practice Address - Street 1:3288 MOANALUA RD
Practice Address - Street 2:
Practice Address - City:HONOLULU
Practice Address - State:HI
Practice Address - Zip Code:96819-1469
Practice Address - Country:US
Practice Address - Phone:808-432-8000
Practice Address - Fax:808-432-8590
Is Sole Proprietor?:No
Enumeration Date:2013-09-11
Last Update Date:2024-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAPA.200664363AM0700X
COPA.0004230363AM0700X
HIAMD-1287363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA2345532Medicaid
LA316900YH54Medicare PIN
LA2345532Medicaid