Provider Demographics
NPI:1104063346
Name:ABNER, LISA (ARNP)
Entity type:Individual
Prefix:
First Name:LISA
Middle Name:
Last Name:ABNER
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 158
Mailing Address - Street 2:
Mailing Address - City:MANCHESTER
Mailing Address - State:KY
Mailing Address - Zip Code:40962-0158
Mailing Address - Country:US
Mailing Address - Phone:606-598-5564
Mailing Address - Fax:606-598-6615
Practice Address - Street 1:103 CHERA LYNN ST
Practice Address - Street 2:
Practice Address - City:LONDON
Practice Address - State:KY
Practice Address - Zip Code:40741-3142
Practice Address - Country:US
Practice Address - Phone:606-864-4764
Practice Address - Fax:606-864-3732
Is Sole Proprietor?:No
Enumeration Date:2009-01-09
Last Update Date:2009-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY1081678363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner