Provider Demographics
NPI:1831763499
Name:DANLEY, LISA KAY
Entity type:Individual
Prefix:
First Name:LISA
Middle Name:KAY
Last Name:DANLEY
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 1:4725 MOBILE HWY STE B
Mailing Address - Street 2:
Mailing Address - City:MONTGOMERY
Mailing Address - State:AL
Mailing Address - Zip Code:36108-5126
Mailing Address - Country:US
Mailing Address - Phone:334-874-8800
Mailing Address - Fax:334-593-8819
Practice Address - Street 1:2611 WOODLEY PARK DR
Practice Address - Street 2:
Practice Address - City:MONTGOMERY
Practice Address - State:AL
Practice Address - Zip Code:36116-3834
Practice Address - Country:US
Practice Address - Phone:334-874-8800
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-05-18
Last Update Date:2021-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL1-106386363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily