Healthcare Provider Details

I. General information

NPI: 1841735339
Provider Name (Legal Business Name): LISA FLEITAS N.P.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/20/2016
Last Update Date: 05/14/2026
Certification Date: 05/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1105 EARL FRYE BLVD
AMORY MS
38821-5500
US

IV. Provider business mailing address

P.O. BOX 381468
GERMANTOWN TN
38183-1468
US

V. Phone/Fax

Practice location:
  • Phone: 662-256-6090
  • Fax: 662-257-6760
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number901768
License Number StateMS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: