Provider Demographics
NPI:1487057568
Name:KISER, LARA ELAINE (FNP-BC)
Entity type:Individual
Prefix:MRS
First Name:LARA
Middle Name:ELAINE
Last Name:KISER
Suffix:
Gender:F
Credentials:FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 765
Mailing Address - Street 2:
Mailing Address - City:CEDAR BLUFF
Mailing Address - State:VA
Mailing Address - Zip Code:24609-0765
Mailing Address - Country:US
Mailing Address - Phone:276-964-7176
Mailing Address - Fax:276-964-7157
Practice Address - Street 1:216 COLLEGE RIDGE ROAD
Practice Address - Street 2:
Practice Address - City:CEDAR BLUFF
Practice Address - State:VA
Practice Address - Zip Code:24609-0765
Practice Address - Country:US
Practice Address - Phone:276-964-7176
Practice Address - Fax:276-964-7157
Is Sole Proprietor?:No
Enumeration Date:2014-10-02
Last Update Date:2014-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0024172068363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily