Provider Demographics
NPI:1548932346
Name:SALYER, LISA Y (NURSE PRACTITIONER)
Entity type:Individual
Prefix:
First Name:LISA
Middle Name:Y
Last Name:SALYER
Suffix:
Gender:F
Credentials:NURSE PRACTITIONER
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4990 UPPER POSSUM CREEK RD
Mailing Address - Street 2:
Mailing Address - City:GATE CITY
Mailing Address - State:VA
Mailing Address - Zip Code:24251-5745
Mailing Address - Country:US
Mailing Address - Phone:423-335-3854
Mailing Address - Fax:
Practice Address - Street 1:4990 UPPER POSSUM CREEK RD
Practice Address - Street 2:
Practice Address - City:GATE CITY
Practice Address - State:VA
Practice Address - Zip Code:24251-5745
Practice Address - Country:US
Practice Address - Phone:423-335-3854
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-09-30
Last Update Date:2021-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0024182727363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Single Specialty