Individual
LISA KEITH
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
425 CUMBERLAND ST, CHATTANOOGA, TN 37404-1909
(423) 698-0802
Mailing address
425 CUMBERLAND ST, CHATTANOOGA, TN 37404-1909
(423) 698-0802
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
Primary
97970
TN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
97970
PACE
TN
Enumeration date
08/10/2012
Last updated
08/10/2012
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