Clark, Lisa Lynn

Clark, Lisa Lynn is an individual health care provider with primary practice located at 4370 W Main Street , Dothan AL 36305. She recently has only one registered license in Physician Assistants & Advanced Practice Nursing Providers / Nurse Anesthetist, Certified Registered, which is considered as her primary health care specialty. Clark, Lisa Lynn can be contacted via phone (334) 793-5000.

Contact Information

Primary practice address
4370 W Main Street Dothan AL 36305
Phone: (334) 793-5000
Fax: (334) 615-8428
Website:
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Health care specialties

SpecialtyCodeLicense #State
Physician Assistants & Advanced Practice Nursing Providers / Nurse Anesthetist, Certified Registered 367500000X 1054427 Alabama

Profile Details

NPI number 1336100130
LBN Legal business name Clark, Lisa Lynn
Credentials Certified Registered Nurse Anesthetist (CRNA)
Entity Individual
Sole proprietor 1 No
Enumeration date Mar 31st, 2006
Last updated Jul 25th, 2011 - about 14 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1336100130 NPPES
Alabama Other 51515740 BLUE CROSS BLUE SHIELD
Alabama MEDICAID 301239500 BLUE CROSS BLUE SHIELD
Alabama Other P00078968 BLUE CROSS BLUE SHIELD
Alabama MEDICAID 000652451B BLUE CROSS BLUE SHIELD
Alabama MEDICAID 051515740 BLUE CROSS BLUE SHIELD

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