Provider Demographics
NPI:1427109115
Name:KAIL, LISA B (FNP)
Entity type:Individual
Prefix:
First Name:LISA
Middle Name:B
Last Name:KAIL
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3065 WILLIAM ST
Mailing Address - Street 2:STE 209
Mailing Address - City:CAPE GIRARDEAU
Mailing Address - State:MO
Mailing Address - Zip Code:63703-6393
Mailing Address - Country:US
Mailing Address - Phone:573-335-4100
Mailing Address - Fax:573-339-7887
Practice Address - Street 1:3065 WILLIAM ST
Practice Address - Street 2:SUITE 209
Practice Address - City:CAPE GIRARDEAU
Practice Address - State:MO
Practice Address - Zip Code:63703-6393
Practice Address - Country:US
Practice Address - Phone:573-335-4100
Practice Address - Fax:573-339-7887
Is Sole Proprietor?:No
Enumeration Date:2007-01-16
Last Update Date:2020-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO140371363LC1500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LC1500XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerCommunity Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO421499401Medicaid
MO763717OtherHEALTHLINK
MO5719955OtherFIRST HEALTH