Provider Demographics
NPI:1992044200
Name:PATTON, LISA G (CFNP)
Entity Type:Individual
Prefix:
First Name:LISA
Middle Name:G
Last Name:PATTON
Suffix:
Gender:F
Credentials:CFNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:155 HEALTH WAY
Mailing Address - Street 2:SUITE 1
Mailing Address - City:MCMINNVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37110-2658
Mailing Address - Country:US
Mailing Address - Phone:931-473-5394
Mailing Address - Fax:931-473-6636
Practice Address - Street 1:155 HEALTH WAY
Practice Address - Street 2:SUITE 1
Practice Address - City:MCMINNVILLE
Practice Address - State:TN
Practice Address - Zip Code:37110-2658
Practice Address - Country:US
Practice Address - Phone:931-473-5394
Practice Address - Fax:931-473-6636
Is Sole Proprietor?:No
Enumeration Date:2013-02-06
Last Update Date:2013-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN17336363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN17336OtherADVANCED PRACTICE NURSE