Provider Demographics
NPI:1932101839
Name:FLETCHER, LISA D (MSN FNP)
Entity Type:Individual
Prefix:
First Name:LISA
Middle Name:D
Last Name:FLETCHER
Suffix:
Gender:F
Credentials:MSN FNP
Other - Prefix:
Other - First Name:LISA
Other - Middle Name:D
Other - Last Name:ARRINGTON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:FNP
Mailing Address - Street 1:1208 EDWARDS ST
Mailing Address - Street 2:
Mailing Address - City:UNION CITY
Mailing Address - State:TN
Mailing Address - Zip Code:38261-5320
Mailing Address - Country:US
Mailing Address - Phone:731-884-8800
Mailing Address - Fax:731-884-0240
Practice Address - Street 1:1208 EDWARDS ST
Practice Address - Street 2:
Practice Address - City:UNION CITY
Practice Address - State:TN
Practice Address - Zip Code:38261-5320
Practice Address - Country:US
Practice Address - Phone:731-884-8800
Practice Address - Fax:731-884-0240
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-11
Last Update Date:2010-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNAPN 000007414363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
4094019OtherBC
3928944Medicare ID - Type Unspecified
Q15793Medicare UPIN