Provider Demographics
NPI:1194703181
Name:ACREE, LISA PINKARD (ANP-BC)
Entity type:Individual
Prefix:
First Name:LISA
Middle Name:PINKARD
Last Name:ACREE
Suffix:
Gender:F
Credentials:ANP-BC
Other - Prefix:
Other - First Name:LISA
Other - Middle Name:MICHELL
Other - Last Name:PINKARD
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:1825 MARTHA BERRY BLVD NW
Mailing Address - Street 2:
Mailing Address - City:ROME
Mailing Address - State:GA
Mailing Address - Zip Code:30165-1625
Mailing Address - Country:US
Mailing Address - Phone:706-295-5331
Mailing Address - Fax:
Practice Address - Street 1:255 W 5TH ST SW
Practice Address - Street 2:
Practice Address - City:ROME
Practice Address - State:GA
Practice Address - Zip Code:30165-2817
Practice Address - Country:US
Practice Address - Phone:706-528-9110
Practice Address - Fax:706-528-9111
Is Sole Proprietor?:No
Enumeration Date:2006-01-09
Last Update Date:2013-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN126710363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
GAP24413Medicare UPIN