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General NPI Number Information
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NPI Number | 1770983785
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Entity Type | Individual
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Provider Name | LISA A CHILDRESS FNP-C, PMHNP-BC
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Gender | Female
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Dates
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Enumeration Date | 08/27/2014
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Last Update Date | 01/30/2025
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Provider Practice Location Address
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Address Line | 400 E STATE ST STE D
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City | ATHENS
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State | OH
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Zip | 45701-1870
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Country | US
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Telephone | 740-326-6110
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Fax |
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Provider Business Mailing Address
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Address Line | 3235 COUNTY ROAD 17
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City | SOUTH POINT
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State | OH
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Zip | 45680-7693
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Country | US
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Telephone | 740-646-5517
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Fax | 606-408-6612
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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 | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number | 71599
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License Number State | WV
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Taxonomy #2
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | 3015890
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License Number State | KY
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Taxonomy #3
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Taxonomy Code | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number | APRN.CNP.022616
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License Number State | OH
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