Provider Demographics
NPI:1922325802
Name:PURDY, LISA R (LPN)
Entity Type:Individual
Prefix:
First Name:LISA
Middle Name:R
Last Name:PURDY
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:799 PINEVIEW DR
Mailing Address - Street 2:
Mailing Address - City:SPRINGVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:38256-4516
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:803 JOY ST
Practice Address - Street 2:
Practice Address - City:PARIS
Practice Address - State:TN
Practice Address - Zip Code:38242-4529
Practice Address - Country:US
Practice Address - Phone:731-642-4025
Practice Address - Fax:731-644-0711
Is Sole Proprietor?:No
Enumeration Date:2010-04-30
Last Update Date:2010-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN74430164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse