Individual
MS. LISA CAROLE PRIMM
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
ARNP
Contact information
Practice address
828 LANE ALLEN RD STE 219, LEXINGTON, KY 40504
(502) 498-4071
(888) 423-5216
Mailing address
PO BOX 3299, CARSON CITY, NV 89702-3299
(775) 240-6758
(888) 700-0187
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
5409P
KY
363LF0000X
Family Nurse Practitioner
Primary
1099062
KY
364SF0001X
Family Health Clinical Nurse Specialist
3005409
KY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
50029934
PASSPORT HEALTH PLAN
KY
05
—
7100050650
—
IN
Enumeration date
09/17/2007
Last updated
07/24/2018
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