Individual
LISA KAY ROOT
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
CRNA
Contact information
Practice address
601 MED TECH PKWY, JOHNSON CITY, TN 37604-2253
(423) 610-1020
Mailing address
1009 LARK ST STE 2, JOHNSON CITY, TN 37604-8218
(423) 283-0776
(423) 968-5697
Taxonomy
Speciality
Code
Description
License number
State
367500000X
Certified Registered Nurse Anesthetist
Primary
RN0000114257
TN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
3625581
—
TN
Enumeration date
08/22/2005
Last updated
04/24/2019
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