Healthcare Provider Details

I. General information

NPI: 1750685673
Provider Name (Legal Business Name): KERRI LU LEVA CISNEY PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/06/2011
Last Update Date: 02/26/2025
Certification Date: 02/26/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2330 THORNTON TAYLOR PKWY STE B
FAYETTEVILLE TN
37334-3673
US

IV. Provider business mailing address

927 FRANKLIN ST SE
HUNTSVILLE AL
35801-4306
US

V. Phone/Fax

Practice location:
  • Phone: 256-539-2728
  • Fax: 256-539-2666
Mailing address:
  • Phone: 256-539-2728
  • Fax: 256-539-2666

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA975
License Number StateAL
# 2
Primary TaxonomyN
Taxonomy Code363AS0400X
TaxonomySurgical Physician Assistant
License NumberPA975
License Number StateAL
# 3
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number2444
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: