MEDICARE: LISA TEACHNOR CRNP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LF0000X	Family Nurse Practitioner	5015192	NC
2	207Q00000X	Family Medicine Physician	1195770	TX
3	207Q00000X	Family Medicine Physician	244988	LA
4	363LF0000X	Family Nurse Practitioner	ARNP 9174159	FL
5	207Q00000X	Family Medicine Physician	888058	NV
6	207Q00000X	Family Medicine Physician	0104919	CO
7	207Q00000X	Family Medicine Physician	907287	MS
8	207Q00000X	Family Medicine Physician	A184089	IA
9	207Q00000X	Family Medicine Physician	232482	AR
10	363LF0000X	Family Nurse Practitioner	57953	WY
11	207Q00000X	Family Medicine Physician	3-002179	AL
12	207Q00000X	Family Medicine Physician	2071296	ID

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1346597515
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LISA TEACHNOR CRNP

Provider Business Mailing Address
First Line	:	5917 OLD SPANISH TRL
Second Line	:
City	:	OCEAN SPRINGS
State	:	MS
Zip	:	39564-6807
Country	:	US
Telephone Number	:	334-504-0079
Fax Number	:

Provider Business Practice Location Address
First Line	:	5917 OLD SPANISH TRL
Second Line	:
City	:	OCEAN SPRINGS
State	:	MS
Zip	:	39564-6807
Country	:	US
Telephone Number	:	334-504-0079
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/07/2012
Last Update Date	:	01/07/2026

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Directions to “ LISA TEACHNOR CRNP” Practice Location

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