Healthcare Provider Details

I. General information

NPI: 1245983337
Provider Name (Legal Business Name): LISA HANNAH ALLEN-CAMPBELL
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/31/2022
Last Update Date: 09/29/2026
Certification Date: 01/19/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

THE SPRINGS AT LAFAYETTE 2402 SOUTH STREET
LAFAYETTE IN
47904
US

IV. Provider business mailing address

3300 HIDDEN LAKE CT
FISHERVILLE KY
40023-9786
US

V. Phone/Fax

Practice location:
  • Phone: 765-340-8125
  • Fax:
Mailing address:
  • Phone: 502-619-1417
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number1082718
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: