Provider Demographics
NPI:1861904823
Name:PAXTON, LISA EILEEN (APRN)
Entity type:Individual
Prefix:MRS
First Name:LISA
Middle Name:EILEEN
Last Name:PAXTON
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:MISS
Other - First Name:LISA
Other - Middle Name:EILEEN
Other - Last Name:WAITE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:200 HUNTCLIFF DR
Mailing Address - Street 2:
Mailing Address - City:JONESBORO
Mailing Address - State:AR
Mailing Address - Zip Code:72404-8842
Mailing Address - Country:US
Mailing Address - Phone:870-404-3448
Mailing Address - Fax:
Practice Address - Street 1:200 HUNTCLIFF DR
Practice Address - Street 2:
Practice Address - City:JONESBORO
Practice Address - State:AR
Practice Address - Zip Code:72404-8842
Practice Address - Country:US
Practice Address - Phone:870-404-3448
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-10-31
Last Update Date:2017-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARA005399363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily