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General NPI Number Information
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NPI Number | 1841503141
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Entity Type | Individual
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Provider Name | MISTI LANE RISNER FNP
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Gender | Female
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Dates
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Enumeration Date | 07/15/2010
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Last Update Date | 07/15/2010
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Provider Practice Location Address
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Address Line | 543 E MAIN ST
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City | HOHENWALD
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State | TN
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Zip | 38462-2007
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Country | US
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Telephone | 931-799-6765
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Fax |
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Provider Business Mailing Address
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Address Line | 2698 WALNUT GROVE RD
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City | WAYNESBORO
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State | TN
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Zip | 38485-5307
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Country | US
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Telephone | 931-332-0952
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Fax | 931-722-2360
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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 | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 207Q00000X
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License Number State | TN
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