Healthcare Provider Details

I. General information

NPI: 1760477947
Provider Name (Legal Business Name): LISA G BENNETT FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: LISA G SAWYERS FNP

II. Dates (important events)

Enumeration Date: 09/14/2005
Last Update Date: 01/12/2025
Certification Date: 01/12/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

212 PARK AVE
BECKLEY WV
25801-6046
US

IV. Provider business mailing address

252 RURAL ACRES DR
BECKLEY WV
25801-3503
US

V. Phone/Fax

Practice location:
  • Phone: 304-252-8551
  • Fax: 304-461-1105
Mailing address:
  • Phone: 304-253-2638
  • Fax: 304-252-1720

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number52885
License Number StateWV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: