Provider Demographics
NPI:1245255082
Name:DUKES, LISA KAA (MSN,ARNP)
Entity type:Individual
Prefix:
First Name:LISA
Middle Name:KAA
Last Name:DUKES
Suffix:
Gender:F
Credentials:MSN,ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:480 HOPKINSVILLE ST
Mailing Address - Street 2:
Mailing Address - City:GREENVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:42345-1124
Mailing Address - Country:US
Mailing Address - Phone:270-338-5777
Mailing Address - Fax:270-338-5765
Practice Address - Street 1:226 HOPKINSVILLE ST
Practice Address - Street 2:
Practice Address - City:GREENVILLE
Practice Address - State:KY
Practice Address - Zip Code:42345-1214
Practice Address - Country:US
Practice Address - Phone:270-338-6488
Practice Address - Fax:270-338-7868
Is Sole Proprietor?:No
Enumeration Date:2006-07-13
Last Update Date:2019-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY4818P363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY7801777900Medicaid
IN200939360Medicaid
IN200939360Medicaid
KYK135230Medicare UPIN