Healthcare Provider Details

I. General information

NPI: 1518420256
Provider Name (Legal Business Name): LISA CONDRA SWAFFORD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/10/2019
Last Update Date: 09/23/2026
Certification Date: 09/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6401 SHALLOWFORD RD
CHATTANOOGA TN
37421-5406
US

IV. Provider business mailing address

790 ARMSTRONG RD SE
CLEVELAND TN
37323-8404
US

V. Phone/Fax

Practice location:
  • Phone: 423-893-6500
  • Fax:
Mailing address:
  • Phone: 423-933-5742
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP2300X
TaxonomyPrimary Care Nurse Practitioner
License Number0000025637
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: