MRS. LISA SMITH (NPI# 1134194160) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1134194160 |
| Entity Type | Individual |
| Full Name | MRS. LISA SMITH |
| Credential | PNP |
| Practice Address |
2905 N Main St Decatur IL 62526-4274 |
| Practice Telephone | 2178779117 |
| Practice Fax Number | 2178773077 |
| Mailing Telephone | 2178779117 |
| Mailing Fax Number | 2178773077 |
| Enumeration Date | 2006-02-22 |
| Last Update Date | 2014-03-13 |
| Gender Code | F |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 363LP0200X |
Nurse Practitioner Specialization: Pediatrics |
209.004906 | IL | Physician Assistants & Advanced Practice Nursing Providers |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1124626403 | Lisa Whyeyeh Smith | Early Intervention Provider Agency | 6143 186th St Ste 436, Fresh Meadows, NY 11365-2710 | 2020-10-09 |
| 1982211280 | Lisa Marie Smith | Pharmacist | 5409 S 60th Pl, Rogers, AR 72758-8230 | 2020-09-30 |
| 1710590757 | Lisa M Smith | Occupational Therapy Assistant | 920 Westacre Rd, West Sacramento, CA 95691-3224 | 2020-08-28 |
| 1013531060 | Lisa Marie Smith | Student in an Organized Health Care Education/Training Program | 1465 County Road 232, Collinsville, TX 76233 | 2020-06-05 |
| 1699300350 | Lisa Kathryn Smith | Registered Nurse | 7913 Lakeview Dr, Denver, NC 28037-9265 | 2020-03-03 |
| 1821637778 | Lisa Ann Smith | Dietitian, Registered | 522 10th St, Aplington, IA 50604-1073 | 2019-12-24 |
| 1700421450 | Lisa Marie Smith | Nurse Practitioner | 4353 Heyward St, North Port, FL 34291-4561 | 2019-11-16 |
| 1982168290 | Lisa Lynn Smith | Acupuncturist | 531 Central Park Avenue, Suite 304, Searsdale, NY 10583 | 2019-01-31 |
| 1649753120 | Lisa Lynn Smith | Occupational Therapist | 355 Dogwood South Ln, Haughton, LA 71037-8511 | 2018-09-11 |
| 1083193270 | Lisa Smith | Occupational Therapist | 243 Raspberry Rd, Leola, PA 17540-2215 | 2018-08-09 |
| Street Address |
2905 N MAIN ST |
| City | DECATUR |
| State | IL |
| Zip Code | 62526-4274 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1811993405 | John C. Kefalas, M.d.,s.c. | Orthopaedic Surgery | 2905 N Main St, Suite G, Decatur, IL 62526-4276 | 2005-06-28 |
| 1508315086 | Decatur Open Mri, Inc. | Clinic/Center | 2905 N Main St, Suite F, Decatur, IL 62526-4276 | 2016-09-26 |
| 1528434222 | Angela L King | Nurse Practitioner | 2905 N Main St, Decatur, IL 62526-4274 | 2015-08-17 |
| 1821407818 | Brentny Renfro | Physician Assistant | 2905 N Main St, Decatur, IL 62526-4274 | 2014-08-05 |
| 1073946141 | Gabrielle K. Sauder | Nurse Practitioner | 2905 N Main St, Decatur, IL 62526-4274 | 2013-08-13 |
| 1770836991 | Community Health Improvement Center | Social Worker | 2905 N Main St, Decatur, IL 62526-4274 | 2012-10-25 |
| 1528349834 | Jessica Ann Conlin | Nurse Practitioner | 2905 N Main St, Decatur, IL 62526-4274 | 2011-08-31 |
| 1285930578 | Amy E Marsili | Social Worker | 2905 N Main St, Decatur, IL 62526-4274 | 2011-02-03 |
| 1053620930 | Cami Jo Kistenfeger | Physician Assistant | 2905 N Main St, Ste. G, Decatur, IL 62526-4274 | 2010-09-27 |
| 1447568605 | Allison M Raiha | Dietitian, Registered | 2905 N Main St, Decatur, IL 62526-4274 | 2010-09-21 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1083100804 | Coalition | Non-emergency Medical Transport (VAN) | 2375 N Longwood Dr, Decatur, IL 62526 | 2018-07-04 |
| 1881116820 | Bria N Howard | Nurse's Aide | 606 E Warren St. Apt 609, Decatur, IL 62526 | 2017-07-12 |
| 1437683679 | Lutheran Child and Family Services | Foster Care Agency | 2826 N. Monroe Street, Decatur, IL 62526 | 2017-04-14 |
| 1083166326 | Whitney Miller | Pharmacist | 225 East Ash Ave, Decatur, IL 62526 | 2016-11-03 |
| 1487053369 | Central Illinois Health Associates, Inc | Preferred Provider Organization | 2300 N. Edward Street, Decatur, IL 62526 | 2014-08-18 |
| 1659787893 | Stephanie Marie Kanitsch | Obstetrics & Gynecology | 544 W Pershing Rd Ste A, Decatur, IL 62526 | 2014-07-09 |
| 1497169973 | Brian Hassinger | Audiologist-Hearing Aid Fitter | 2605 N Water St Ste 101, Decatur, IL 62526 | 2014-06-12 |
| 1891041570 | Decatur 2016 LLC | Dentist | 141 Epershing Rd, Decatur, IL 62526 | 2012-07-31 |
| 1558639005 | Larry Lee Christensen | Pharmacist | 225 Ash Ave, Decatur, IL 62526 | 2011-12-12 |
| 1174821540 | Nathan Pyle | Internal Medicine | 2 Memorial Dr Ste 101, Decatur, IL 62526 | 2011-03-08 |
| Find all providers in zip 62526 | ||||
| Taxonomy Code | 363LP0200X |
| Grouping | Physician Assistants & Advanced Practice Nursing Providers |
| Classification | Nurse Practitioner |
| Specialization | Pediatrics |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1659992899 | Mallory Maryruth Gray | Nurse Practitioner | 350 Winn Way, Decatur, GA 30030-2106 | 2020-04-28 |
| 1245656768 | Gayla Woodson | Nurse Practitioner | 2785 Lawrenceville Hwy, Suite 207, Decatur, GA 30033-2515 | 2014-03-07 |
| 1073946141 | Gabrielle K. Sauder | Nurse Practitioner | 2905 N Main St, Decatur, IL 62526-4274 | 2013-08-13 |
| 1316253578 | Linda S Pietrzak | Nurse Practitioner | 1900 E Lake Shore Dr, Suite 330, Decatur, IL 62521-3824 | 2010-08-26 |
| 1154646917 | Camille N Cobb | Nurse Practitioner | 2000 S Fm 51, Decatur, TX 76234-3702 | 2010-04-05 |
| 1568627255 | Anderia Shirrell Rhodes-bigham | Nurse Practitioner | 2855 Candler Rd, Suite 9, Decatur, GA 30034-1415 | 2008-07-23 |
| 1407055353 | Amy L Kindred Johnson | Nurse Practitioner | 1900 E Lake Shore Dr, Suite 330, Decatur, IL 62521-3848 | 2007-07-12 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1740881291 | Sarah Zeigler Olsen | Nurse Practitioner | 600 S Randall Rd Ste 220, Algonquin, IL 60102-5937 | 2020-11-02 |
| 1467051151 | Mallory Jo Brooks | Nurse Practitioner | 2306 E County Road 1800 N, Carthage, IL 62321-3101 | 2020-10-22 |
| 1508475294 | Diedra M Ahlert | Nurse Practitioner | 1320 Lexington Dr, Collinsville, IL 62234-4348 | 2020-07-28 |
| 1679182802 | Danielle L Shubert | Nurse Practitioner | 9423 Holy Cross Ln Ste 111, Breese, IL 62230-3510 | 2020-07-23 |
| 1154962900 | Janna Hoppe | Nurse Practitioner | 24600 W 127th St Ste 345, Plainfield, IL 60585-9507 | 2019-10-02 |
| 1841858529 | Katherine R Conkling | Nurse Practitioner | 4941 Benchmark Centre Dr Ste 100, Swansea, IL 62226-2038 | 2019-05-29 |
| 1942767280 | Danielle R Wetzel | Nurse Practitioner | 2040 Ogden Ave Ste 215, Aurora, IL 60504-7205 | 2019-02-22 |
| 1669937231 | Colleen Ann Larkin | Nurse Practitioner | 10939 S Troy St, Chicago, IL 60655-2211 | 2019-02-07 |
| 1568939684 | Katelyn Marie Reed | Nurse Practitioner | 415 N 9th St Ste 4w64, Springfield, IL 62702-5303 | 2018-10-26 |
| 1255813218 | Michelle Christine Bollinger | Nurse Practitioner | 415 N 9th St Ste 4w16, Springfield, IL 62702-5303 | 2018-09-05 |
| Find all providers with the same taxonomy | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.