Healthcare Provider Details

I. General information

NPI: 1093190431
Provider Name (Legal Business Name): LISA SUMMERS FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/28/2015
Last Update Date: 12/03/2025
Certification Date: 12/03/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

408 ALEXANDER STREET
CEDAR GROVE WV
25309
US

IV. Provider business mailing address

2585 3RD AVE
HUNTINGTON WV
25703-1642
US

V. Phone/Fax

Practice location:
  • Phone: 304-595-1770
  • Fax: 304-595-3298
Mailing address:
  • Phone: 304-697-1396
  • Fax: 304-697-2086

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number71874
License Number StateWV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: