Provider Demographics
NPI:1881950103
Name:HEMPHILL, LISA M (ACNP)
Entity type:Individual
Prefix:
First Name:LISA
Middle Name:M
Last Name:HEMPHILL
Suffix:
Gender:F
Credentials:ACNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2357 WILLOWGROVE AVE
Mailing Address - Street 2:
Mailing Address - City:KETTERING
Mailing Address - State:OH
Mailing Address - Zip Code:45409-1955
Mailing Address - Country:US
Mailing Address - Phone:937-253-6631
Mailing Address - Fax:
Practice Address - Street 1:3080 ACKERMAN BLVD
Practice Address - Street 2:STE 100
Practice Address - City:KETTERING
Practice Address - State:OH
Practice Address - Zip Code:45429-3555
Practice Address - Country:US
Practice Address - Phone:937-396-1605
Practice Address - Fax:888-368-2122
Is Sole Proprietor?:No
Enumeration Date:2012-04-11
Last Update Date:2021-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH2011021336363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
OHH094212Medicare PIN