Provider Demographics
NPI:1750554069
Name:TODD, LISA ANN (NP-C)
Entity type:Individual
Prefix:MISS
First Name:LISA
Middle Name:ANN
Last Name:TODD
Suffix:
Gender:F
Credentials:NP-C
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Mailing Address - Street 1:116 LEBANON TRADE CENTER DR
Mailing Address - Street 2:
Mailing Address - City:LEBANON
Mailing Address - State:KY
Mailing Address - Zip Code:40033-1821
Mailing Address - Country:US
Mailing Address - Phone:270-225-1005
Mailing Address - Fax:270-310-8141
Practice Address - Street 1:116 LEBANON TRADE CENTER DR
Practice Address - Street 2:
Practice Address - City:LEBANON
Practice Address - State:KY
Practice Address - Zip Code:40033-1821
Practice Address - Country:US
Practice Address - Phone:270-225-1005
Practice Address - Fax:270-310-8141
Is Sole Proprietor?:Yes
Enumeration Date:2008-04-08
Last Update Date:2025-06-13
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
KY3005560363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY7100077760Medicaid