Mallard, Lisa

Mallard, Lisa is an individual health care provider with primary practice located at 170 N Eagle Creek Dr Ste 104 , Lexington KY 40509-9087. She recently has only one registered license in Physician Assistants & Advanced Practice Nursing Providers / Advanced Practice Midwife, which is considered as her primary health care specialty. Mallard, Lisa can be contacted via phone (859) 967-5848.

Contact Information

Primary practice address
170 N Eagle Creek Dr Ste 104 Lexington KY 40509-9087
Phone: (859) 967-5848
Fax: (859) 967-5473
Website:
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Health care specialties

SpecialtyCodeLicense #State
Physician Assistants & Advanced Practice Nursing Providers / Advanced Practice Midwife 367A00000X ARNP 2157582 Florida
Physician Assistants & Advanced Practice Nursing Providers / Advanced Practice Midwife 367A00000X 3009349 Kentucky

Profile Details

NPI number 1891847869
LBN Legal business name Mallard, Lisa
Credentials ARNP, CNM
Entity Individual
Sole proprietor 1 No
Enumeration date Jan 18th, 2007
Last updated Dec 14th, 2022 - about 2 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 1891847869 NPPES
Kentucky MEDICAID 7100503870

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