Healthcare Provider Details

I. General information

NPI: 1841300597
Provider Name (Legal Business Name): LISA R DORAN FNP, PMH-NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/30/2006
Last Update Date: 02/01/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1101 E STONE DR SUITE 2
KINGSPORT TN
37660-3384
US

IV. Provider business mailing address

1101 E STONE DR SUITE 2
KINGSPORT TN
37660-3384
US

V. Phone/Fax

Practice location:
  • Phone: 423-224-1110
  • Fax: 423-224-1130
Mailing address:
  • Phone: 423-224-1110
  • Fax: 423-224-1130

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAPN0000008088
License Number StateTN
# 2
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number0024169737
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: