Healthcare Provider Details

I. General information

NPI: 1417071689
Provider Name (Legal Business Name): LISA N LONG FNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: LISA HINEY

II. Dates (important events)

Enumeration Date: 03/16/2007
Last Update Date: 05/17/2023
Certification Date: 05/17/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 TRILLIUM WAY
CORBIN KY
40701-8426
US

IV. Provider business mailing address

800 OAK RIDGE TPKE STE C100
OAK RIDGE TN
37830-6927
US

V. Phone/Fax

Practice location:
  • Phone: 606-523-8770
  • Fax: 865-482-4400
Mailing address:
  • Phone: 865-483-2288
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WP0808X
TaxonomyPsychiatric/Mental Health Registered Nurse
License NumberRN158278
License Number StateTN
# 2
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number6401P
License Number StateKY
# 3
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAPN14799
License Number StateTN
# 4
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number3006401
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: