Healthcare Provider Details

I. General information

NPI: 1902899867
Provider Name (Legal Business Name): LISA ERIN WHITLEY PMHS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: LISA ERIN WHITLEY

II. Dates (important events)

Enumeration Date: 08/25/2005
Last Update Date: 11/27/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

129 WOODSON ST
SALISBURY NC
28144-3255
US

IV. Provider business mailing address

129 WOODSON ST
SALISBURY NC
28144-3255
US

V. Phone/Fax

Practice location:
  • Phone: 704-636-5576
  • Fax: 704-636-1755
Mailing address:
  • Phone: 704-636-5576
  • Fax: 704-636-1755

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number5000717
License Number StateNC
# 2
Primary TaxonomyY
Taxonomy Code363LP0200X
TaxonomyPediatric Nurse Practitioner
License Number5000717
License Number StateNC
# 3
Primary TaxonomyN
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number5000717
License Number StateNC
# 4
Primary TaxonomyN
Taxonomy Code363LP1700X
TaxonomyPerinatal Nurse Practitioner
License Number5000717
License Number StateNC
# 5
Primary TaxonomyN
Taxonomy Code363LP2300X
TaxonomyPrimary Care Nurse Practitioner
License Number5000717
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: