Provider Demographics
NPI:1790316115
Name:DICKEY, LISA RENEE (APRN, FNP-C)
Entity type:Individual
Prefix:
First Name:LISA
Middle Name:RENEE
Last Name:DICKEY
Suffix:
Gender:F
Credentials:APRN, FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:32 S BROADVIEW ST
Mailing Address - Street 2:
Mailing Address - City:GREENBRIER
Mailing Address - State:AR
Mailing Address - Zip Code:72058-9601
Mailing Address - Country:US
Mailing Address - Phone:501-456-4001
Mailing Address - Fax:501-456-4002
Practice Address - Street 1:PO BOX 689022
Practice Address - Street 2:
Practice Address - City:FRANKLIN
Practice Address - State:TN
Practice Address - Zip Code:37068-9022
Practice Address - Country:US
Practice Address - Phone:615-465-7390
Practice Address - Fax:615-628-6877
Is Sole Proprietor?:No
Enumeration Date:2020-02-04
Last Update Date:2025-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN23609363LF0000X
AL1-203666363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily