MEDICARE: MS. LISA CORRELL FISHER FNP

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	148858	NC
2	363LF0000X	Family Nurse Practitioner	25982	SC

General Provider Information

NPI Number	:	1417407230
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. LISA CORRELL FISHER FNP

Provider Business Mailing Address
First Line	:	2000 HEALTH PARK DR
Second Line	:
City	:	BRENTWOOD
State	:	TN
Zip	:	37027-4692
Country	:	US
Telephone Number	:	615-373-7600
Fax Number	:	833-675-2458

Provider Business Practice Location Address
First Line	:	440 N DUNCAN BYP
Second Line	:
City	:	UNION
State	:	SC
Zip	:	29379-8604
Country	:	US
Telephone Number	:	864-424-9576
Fax Number	:	864-441-0288

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

Provider Enumeration Date	:	10/05/2016
Last Update Date	:	04/02/2025

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