Healthcare Provider Details

I. General information

NPI: 1649193699
Provider Name (Legal Business Name): LISA WHORTON
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/04/2026
Last Update Date: 08/04/2026
Certification Date: 08/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1007 N JEFFERS ST
NORTH PLATTE NE
69101-3028
US

IV. Provider business mailing address

706 E PHILIP AVE APT 104
NORTH PLATTE NE
69101-6164
US

V. Phone/Fax

Practice location:
  • Phone: 308-532-3960
  • Fax:
Mailing address:
  • Phone: 402-446-2428
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code372500000X
TaxonomyChore Provider
License Number
License Number StateNE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: