Provider Demographics
NPI:1750402400
Name:OWENS, LISA
Entity type:Individual
Prefix:
First Name:LISA
Middle Name:
Last Name:OWENS
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:PO BOX 717
Mailing Address - Street 2:
Mailing Address - City:JONESBORO
Mailing Address - State:AR
Mailing Address - Zip Code:72403-0717
Mailing Address - Country:US
Mailing Address - Phone:870-934-1099
Mailing Address - Fax:870-935-1754
Practice Address - Street 1:1201 FLEMING AVENUE
Practice Address - Street 2:
Practice Address - City:JONESBORO
Practice Address - State:AR
Practice Address - Zip Code:72401-3101
Practice Address - Country:US
Practice Address - Phone:870-934-1099
Practice Address - Fax:870-935-1754
Is Sole Proprietor?:No
Enumeration Date:2007-04-02
Last Update Date:2013-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARP00976363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
ARP00976OtherREGISTER NURSE PRACTIONER
ARR32910OtherREGISTERED NURSE
ARR32910OtherREGISTERED NURSE