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General NPI Number Information
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NPI Number | 1750685673
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Entity Type | Individual
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Provider Name | KERRI LU LEVA CISNEY PA-C
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Gender | Female
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Dates
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Enumeration Date | 01/06/2011
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Last Update Date | 02/26/2025
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Provider Practice Location Address
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Address Line | 2330 THORNTON TAYLOR PKWY STE B
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City | FAYETTEVILLE
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State | TN
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Zip | 37334-3673
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Country | US
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Telephone | 256-539-2728
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Fax | 256-539-2666
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Provider Business Mailing Address
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Address Line | 927 FRANKLIN ST SE
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City | HUNTSVILLE
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State | AL
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Zip | 35801-4306
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Country | US
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Telephone | 256-539-2728
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Fax | 256-539-2666
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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 | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | PA975
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License Number State | AL
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Taxonomy #2
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Taxonomy Code | 363AS0400X
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Taxonomy Name | Surgical Physician Assistant
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License Number | PA975
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License Number State | AL
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Taxonomy #3
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | 2444
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License Number State | TN
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