Provider Demographics
NPI:1023316890
Name:CALDWELL, LISA K (APRN)
Entity type:Individual
Prefix:MRS
First Name:LISA
Middle Name:K
Last Name:CALDWELL
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:MRS
Other - First Name:LISA
Other - Middle Name:R
Other - Last Name:CALDWELL
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:APRN
Mailing Address - Street 1:3229 SUMMIT SQUARE PL STE 200
Mailing Address - Street 2:
Mailing Address - City:LEXINGTON
Mailing Address - State:KY
Mailing Address - Zip Code:40509-2647
Mailing Address - Country:US
Mailing Address - Phone:859-333-1477
Mailing Address - Fax:859-543-0079
Practice Address - Street 1:3229 SUMMIT SQUARE PL STE 200
Practice Address - Street 2:
Practice Address - City:LEXINGTON
Practice Address - State:KY
Practice Address - Zip Code:40509-2647
Practice Address - Country:US
Practice Address - Phone:859-333-1477
Practice Address - Fax:859-543-0079
Is Sole Proprietor?:No
Enumeration Date:2011-03-03
Last Update Date:2024-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY3006792363LF0000X, 2084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY7100180000Medicaid
KYK032523Medicare PIN