Healthcare Provider Details

I. General information

NPI: 1922776061
Provider Name (Legal Business Name): LISA KEYS RN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/02/2021
Last Update Date: 08/20/2024
Certification Date: 08/20/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2611 WAYNE AVE
DAYTON OH
45420-1833
US

IV. Provider business mailing address

6400 E BROAD ST FL 4
COLUMBUS OH
43213-2086
US

V. Phone/Fax

Practice location:
  • Phone: 937-256-7801
  • Fax:
Mailing address:
  • Phone: 614-655-3345
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WP0809X
TaxonomyAdult Psychiatric/Mental Health Registered Nurse
License NumberRN289461
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: