Individual
LISA MARIE WOOTEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
APRN
Contact information
Practice address
4402 CHURCHMAN AVE STE 201, LOUISVILLE, KY 40215-3100
(502) 416-0207
Mailing address
PO BOX 909, LOUISVILLE, KY 40201-0909
(502) 416-0207
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
Primary
3007613
KY
363LA2200X
Adult Health Nurse Practitioner
3007613
KY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
7100218830
—
KY
Enumeration date
09/13/2012
Last updated
05/18/2021
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