Provider Demographics
NPI:1184698193
Name:KEOWN, LISA MICHELLE (ARNP)
Entity type:Individual
Prefix:
First Name:LISA
Middle Name:MICHELLE
Last Name:KEOWN
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:851 MCINTOSH DR
Mailing Address - Street 2:
Mailing Address - City:TAYLORSVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40071-8407
Mailing Address - Country:US
Mailing Address - Phone:502-477-2911
Mailing Address - Fax:
Practice Address - Street 1:851 MCINTOSH DR
Practice Address - Street 2:
Practice Address - City:TAYLORSVILLE
Practice Address - State:KY
Practice Address - Zip Code:40071-8407
Practice Address - Country:US
Practice Address - Phone:502-477-2911
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-02-15
Last Update Date:2010-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY3968P363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY78903952Medicaid
KY0966601Medicare ID - Type Unspecified
P83220Medicare UPIN