Provider Demographics
NPI:1841300597
Name:DORAN, LISA R (FNP, PMH-NP)
Entity type:Individual
Prefix:
First Name:LISA
Middle Name:R
Last Name:DORAN
Suffix:
Gender:F
Credentials:FNP, PMH-NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1101 E STONE DR
Mailing Address - Street 2:SUITE 2
Mailing Address - City:KINGSPORT
Mailing Address - State:TN
Mailing Address - Zip Code:37660-3384
Mailing Address - Country:US
Mailing Address - Phone:423-224-1110
Mailing Address - Fax:423-224-1130
Practice Address - Street 1:1101 E STONE DR
Practice Address - Street 2:SUITE 2
Practice Address - City:KINGSPORT
Practice Address - State:TN
Practice Address - Zip Code:37660-3384
Practice Address - Country:US
Practice Address - Phone:423-224-1110
Practice Address - Fax:423-224-1130
Is Sole Proprietor?:No
Enumeration Date:2006-08-30
Last Update Date:2017-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNAPN0000008088363LF0000X, 363LP0200X, 363LP0808X, 363LP2300X
VA0024169737363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics
No363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
TNQ003287Medicaid
TNP00939258OtherRAILROAD MEDICARE
VA1841300597Medicaid
VAVV4541AMedicare PIN
TNP00939258OtherRAILROAD MEDICARE
TN3709285Medicare UPIN
TN36437781Medicare PIN