Healthcare Provider Details

I. General information

NPI: 1467788505
Provider Name (Legal Business Name): LISA A VOUSDEN PMHNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/25/2009
Last Update Date: 06/24/2025
Certification Date: 10/09/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

110 AUBURN AVE
SHELBY OH
44875-1171
US

IV. Provider business mailing address

110 AUBURN AVE
SHELBY OH
44875-1171
US

V. Phone/Fax

Practice location:
  • Phone: 419-342-4242
  • Fax: 419-347-1873
Mailing address:
  • Phone: 419-342-4242
  • Fax: 419-347-1873

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number0037890
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number316281
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: