Provider Demographics
NPI:1962409334
Name:HARVEY, LISA D (ANP)
Entity type:Individual
Prefix:MRS
First Name:LISA
Middle Name:D
Last Name:HARVEY
Suffix:
Gender:F
Credentials:ANP
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 21850
Mailing Address - Street 2:
Mailing Address - City:HOT SPRINGS
Mailing Address - State:AR
Mailing Address - Zip Code:71903-1850
Mailing Address - Country:US
Mailing Address - Phone:501-520-5476
Mailing Address - Fax:501-520-5486
Practice Address - Street 1:4419 N HIGHWAY 7
Practice Address - Street 2:
Practice Address - City:HOT SPRINGS
Practice Address - State:AR
Practice Address - Zip Code:71909-9301
Practice Address - Country:US
Practice Address - Phone:501-922-2217
Practice Address - Fax:501-922-4216
Is Sole Proprietor?:Yes
Enumeration Date:2005-06-30
Last Update Date:2016-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARA004393363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS07671891Medicaid
MS431319531OtherBLUE CROSS BLUE SHIELD
AR210466758Medicaid
MS302I507587OtherMEDICARE
AR447684YKDYMedicare PIN
MS07671891Medicaid