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General NPI Number Information
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NPI Number | 1053095323
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Entity Type | Individual
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Provider Name | LISA LYNN LIVINGSTON APRN
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Gender | Female
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Dates
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Enumeration Date | 06/14/2023
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Last Update Date | 06/14/2023
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Provider Practice Location Address
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Address Line | 1633 S LAKE DR
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City | LEXINGTON
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State | SC
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Zip | 29073-7755
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Country | US
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Telephone | 803-520-9380
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Fax | 803-520-5972
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Provider Business Mailing Address
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Address Line | 2214 OLD CHEROKEE RD
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City | LEXINGTON
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State | SC
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Zip | 29072-9725
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Country | US
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Telephone | 803-520-9380
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Fax | 803-520-5972
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LP0200X
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Taxonomy Name | Pediatric Nurse Practitioner
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License Number | 27494
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License Number State | SC
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