Individual
MRS. LISA JOI OETJEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
APRN, FNP-C
Contact information
Practice address
4787 ALBEN BARKLEY DR, PADUCAH, KY 42001-6789
(270) 442-9461
(270) 441-0079
Mailing address
510 LINCOLN DR, HERRIN, IL 62948-6334
(618) 997-6800
(618) 997-1187
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
3007393
KY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000811812
ANTHEM
KY
05
—
7100238100
—
KY
Enumeration date
03/22/2012
Last updated
03/14/2017
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