Individual
LISA A CUNNINGHAM
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
FNP
Contact information
Practice address
1605 MARTIN SPRINGS DR, STE 250, ROLLA, MO 65401-2931
(573) 458-6363
(573) 458-6765
Mailing address
PO BOX 2580, SPRINGFIELD, MO 65801-2580
(417) 829-4620
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
2012035124
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1790037950
—
MO
01
—
431560263
TRICARE
MO
01
—
P01116108
RR MCR
MO
Enumeration date
10/11/2012
Last updated
08/22/2019
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