Provider Demographics
NPI:1841503141
Name:RISNER, MISTI LANE (FNP)
Entity type:Individual
Prefix:MRS
First Name:MISTI
Middle Name:LANE
Last Name:RISNER
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2698 WALNUT GROVE RD
Mailing Address - Street 2:
Mailing Address - City:WAYNESBORO
Mailing Address - State:TN
Mailing Address - Zip Code:38485-5307
Mailing Address - Country:US
Mailing Address - Phone:931-332-0952
Mailing Address - Fax:931-722-2360
Practice Address - Street 1:543 E MAIN ST
Practice Address - Street 2:
Practice Address - City:HOHENWALD
Practice Address - State:TN
Practice Address - Zip Code:38462-2007
Practice Address - Country:US
Practice Address - Phone:931-799-6765
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-07-15
Last Update Date:2010-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN207Q00000X207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine