Provider Demographics
NPI:1659092666
Name:GOODRICH, LISA KAY (APRN)
Entity type:Individual
Prefix:
First Name:LISA
Middle Name:KAY
Last Name:GOODRICH
Suffix:
Gender:
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4031 COLONEL GLENN HWY
Mailing Address - Street 2:STE 133
Mailing Address - City:BEAVERCREEK
Mailing Address - State:OH
Mailing Address - Zip Code:45431-2774
Mailing Address - Country:US
Mailing Address - Phone:552-320-6448
Mailing Address - Fax:888-546-0488
Practice Address - Street 1:4031 COLONEL GLENN HWY
Practice Address - Street 2:STE 133
Practice Address - City:BEAVERCREEK
Practice Address - State:OH
Practice Address - Zip Code:45431-2774
Practice Address - Country:US
Practice Address - Phone:552-320-6448
Practice Address - Fax:888-546-0488
Is Sole Proprietor?:No
Enumeration Date:2022-09-07
Last Update Date:2025-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHF07221838363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner