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Provider Information for 1710428461

Please Note: Issuance of an NPI does not ensure or validate that the Health Care Provider is Licensed or Credentialed. For more information please refer to NPI: What You Need to Know

LISA CONNELLY FNP-C

Gender: FEMALE

Individual NPI: 1710428461

Calendar   Last Updated:  2018-04-17
  Certification Date: 

Details

Name Value
NPI 1710428461
Enumeration Date 2017-03-14
NPI Type 1 - Individual
Sole Proprietor NO
Status Active
Mailing Address 1505 W 4TH ST
COFFEYVILLE, KS 67337-3307
United States

Phone: 620-251-2400 | Fax: 620-251-1619
View Map External Link
Primary Practice Address 420 W 15TH AVE
EMPORIA, KS 66801-5367
United States

Phone: 620-251-2400 | Fax: 620-251-1619
View Map External Link
Health Information Exchange
Endpoint Type Endpoint Endpoint Description Use Content Type Affiliation Endpoint Location
Other Identifiers
Issuer State Number
Taxonomy
Primary Taxonomy Selected Taxonomy State License Number
Yes 363LF0000X - Nurse Practitioner Family KS 77645