Basic Information
| Provider Information | |||||||||
| NPI: | 1023002631 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | HUNT | ||||||||
| FirstName: | LISA | ||||||||
| MiddleName: | CASTELLAW | ||||||||
| NamePrefix: | |||||||||
| NameSuffix: | |||||||||
| Credential: | FNP APN | ||||||||
| OtherOrganizationName: | |||||||||
| OtherOrganizationType: | |||||||||
| OtherLastName: | CASTELLAW | ||||||||
| OtherFirstName: | LISA | ||||||||
| OtherMiddleName: | |||||||||
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| OtherCredential: | FNP APN | ||||||||
| OtherLastNameType: | 1 | ||||||||
| Mailing Information | |||||||||
| Address1: | 1700 WOODLAWN AVE | ||||||||
| Address2: | |||||||||
| City: | DYERSBURG | ||||||||
| State: | TN | ||||||||
| PostalCode: | 380242028 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7312874500 | ||||||||
| FaxNumber: | 7312874804 | ||||||||
| Practice Location | |||||||||
| Address1: | 624 NORA DRIVE | ||||||||
| Address2: | |||||||||
| City: | NEWBERN | ||||||||
| State: | TN | ||||||||
| PostalCode: | 38059 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7316279560 | ||||||||
| FaxNumber: | 7316279518 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/09/2005 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| NPIReactivationDate: | |||||||||
| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | |||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363L00000X | RN83686 | TN | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | 363L00000X | APN6424 | TN | N | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner |
ID Information
| ID | Type | State | Issuer | Description | 3101540 | 01 | BLUE CROSS | OTHER | 8857 | 01 | TLC MEMPHIS MANAGED CARE | OTHER | 116244 | 01 | BETTER HEALTH PLAN | OTHER | 3345045 | 05 | TN | MEDICAID | 3101540 | 01 | TN | BL CROSS | OTHER |