Healthcare Provider Details

I. General information

NPI: 1043124472
Provider Name (Legal Business Name): LISA CORNEAL
Entity Type: Individual
Gender:
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/01/2026
Last Update Date: 10/01/2026
Certification Date: 10/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

239 HOSPITAL CIR
PARIS TN
38242-4550
US

IV. Provider business mailing address

PO BOX 269084 DEPT 1102
OKLAHOMA CITY OK
73126-9084
US

V. Phone/Fax

Practice location:
  • Phone: 731-394-1145
  • Fax:
Mailing address:
  • Phone: 731-394-1145
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number244811
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: