Provider Demographics
NPI:1730360710
Name:WILLIAMS, LISA M (ARNP)
Entity type:Individual
Prefix:
First Name:LISA
Middle Name:M
Last Name:WILLIAMS
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 950248
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40295-0248
Mailing Address - Country:US
Mailing Address - Phone:502-489-5730
Mailing Address - Fax:502-489-5753
Practice Address - Street 1:4003 KRESGE WAY STE 400
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40207-4652
Practice Address - Country:US
Practice Address - Phone:502-895-4263
Practice Address - Fax:502-899-5488
Is Sole Proprietor?:No
Enumeration Date:2007-11-19
Last Update Date:2020-12-16
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
KY4753P363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY50017859OtherPASSPORT- NCMA- ENDO
KY1055525OtherRN LICENSE
KY4753POtherARNP LICENSE
KY3498297000OtherPASSPORT ADVANTAGE- NCMA- ENDO
KYP00460513OtherRAILROAD MEDICARE- NORTON CMA
KY092426OtherSIHO- NORTON
KY000023029MOtherHUMANA- NORTON
IN200889880OtherMEDICAID INDIANA- NORTON CMA
IN28095453AOtherLICENSE
KY7100024560Medicaid
KY000000545742OtherANTHEM- NORTON
KY611276316-053OtherTRICARE- NORTON
KY000000545742OtherANTHEM- NORTON