MEDICARE: LISA KAY STIMPSON 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	363LP2300X	Primary Care Nurse Practitioner	42450	ID
2	363LF0000X	Family Nurse Practitioner	166582	AK

General Provider Information

NPI Number	:	1558986521
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LISA KAY STIMPSON FNP

Provider Business Mailing Address
First Line	:	7033 E TUDOR RD
Second Line	:
City	:	ANCHORAGE
State	:	AK
Zip	:	99507-1262
Country	:	US
Telephone Number	:	907-729-8901
Fax Number	:	907-729-5180

Provider Business Practice Location Address
First Line	:	1 FLIGHT LINE RD
Second Line	:
City	:	PORT ALSWORTH
State	:	AK
Zip	:	99653-9801
Country	:	US
Telephone Number	:	907-781-2256
Fax Number	:	907-781-2257

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

Provider Enumeration Date	:	06/15/2020
Last Update Date	:	01/15/2025

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