Healthcare Provider Details

I. General information

NPI: 1699100768
Provider Name (Legal Business Name): LISA KAY SMITH FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: LISA KAY SANDERS

II. Dates (important events)

Enumeration Date: 09/09/2013
Last Update Date: 03/16/2023
Certification Date: 03/16/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 S 2ND ST
MONROE LA
71201-8537
US

IV. Provider business mailing address

PO BOX 899
COLUMBIA LA
71418-0899
US

V. Phone/Fax

Practice location:
  • Phone: 318-322-7836
  • Fax:
Mailing address:
  • Phone: 318-649-6111
  • Fax: 318-649-5094

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAP07385
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: