Provider Demographics
NPI:1356535967
Name:DAVIS-BLOOMER, LISA K
Entity type:Individual
Prefix:MRS
First Name:LISA
Middle Name:K
Last Name:DAVIS-BLOOMER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:434 SCOTT ST FL 2
Mailing Address - Street 2:FAMILY SERVICE
Mailing Address - City:COVINGTON
Mailing Address - State:KY
Mailing Address - Zip Code:41011-1528
Mailing Address - Country:US
Mailing Address - Phone:859-291-1121
Mailing Address - Fax:859-655-4882
Practice Address - Street 1:434 SCOTT ST FL 2
Practice Address - Street 2:FAMILY SERVICE
Practice Address - City:COVINGTON
Practice Address - State:KY
Practice Address - Zip Code:41011-1528
Practice Address - Country:US
Practice Address - Phone:859-291-1121
Practice Address - Fax:859-655-4882
Is Sole Proprietor?:No
Enumeration Date:2007-08-28
Last Update Date:2007-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator