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NPI Code Detail

MEDICARE: MS. LISA KAYE PROFFITT APRN

MEDICARE: MS. LISA KAYE PROFFITT APRN
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1363LF0000XFamily Nurse Practitioner3005252KY
2363L00000XNurse Practitioner5252PKY
3363L00000XNurse Practitioner3005252KY

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1649460544
Entity Type Code : Individual
Provider Name (Legal Business Name) : MS. LISA KAYE PROFFITT APRN
Provider Business Mailing Address
First Line : 201 PARK ST
Second Line :
City : BOWLING GREEN
State : KY
Zip : 42101-1742
Country : US
Telephone Number : 270-781-5111
Fax Number :
Provider Business Practice Location Address
First Line : 405 S L ROGERS WELLS BLVD
Second Line :
City : GLASGOW
State : KY
Zip : 42141-1725
Country : US
Telephone Number : 270-479-0260
Fax Number : 270-361-5001
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/26/2007
Last Update Date : 01/22/2025

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