Healthcare Provider Details

I. General information

NPI: 1780441188
Provider Name (Legal Business Name): LISA L DELONEY NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/01/2024
Last Update Date: 10/30/2024
Certification Date: 10/30/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1435 W MAIN ST
DOTHAN AL
36301-1311
US

IV. Provider business mailing address

1435 W MAIN ST
DOTHAN AL
36301-1311
US

V. Phone/Fax

Practice location:
  • Phone: 334-794-7847
  • Fax:
Mailing address:
  • Phone: 334-794-7847
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberF02240726
License Number StateAL
# 2
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number1-065545
License Number StateAL
# 3
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberF02240726
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: