Provider Demographics
NPI:1477907616
Name:RHEA, LISA COLLUMS (NP-C)
Entity type:Individual
Prefix:
First Name:LISA
Middle Name:COLLUMS
Last Name:RHEA
Suffix:
Gender:F
Credentials:NP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8 FRONT ST
Mailing Address - Street 2:
Mailing Address - City:BELMONT
Mailing Address - State:MS
Mailing Address - Zip Code:38827-7764
Mailing Address - Country:US
Mailing Address - Phone:662-454-1170
Mailing Address - Fax:
Practice Address - Street 1:8 FRONT ST
Practice Address - Street 2:
Practice Address - City:BELMONT
Practice Address - State:MS
Practice Address - Zip Code:38827
Practice Address - Country:US
Practice Address - Phone:662-454-1170
Practice Address - Fax:662-454-1062
Is Sole Proprietor?:Yes
Enumeration Date:2016-04-13
Last Update Date:2019-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS901494363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily