Lisa Dian Smith, FNP-C

Primary specialty

Nurse PractitionerTaxonomy code 363L00000X

License

RN176448 Issued in GA

Practice address

1806 Lee Ave
Tifton, GA 31794-3639

Phone

(229) 386-1528

Fax

(229) 388-0556

NPI assigned

Sep 4, 2013

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other names 1

• Miss Lisa Dian Mixon Former name

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1378252800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1378252800000",
    "number": "1003241522",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1806 LEE AVE",
            "city": "TIFTON",
            "state": "GA",
            "postal_code": "317943639",
            "telephone_number": "229-386-1528",
            "fax_number": "229-388-0556"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1806 LEE AVE",
            "city": "TIFTON",
            "state": "GA",
            "postal_code": "317943639",
            "telephone_number": "229-386-1528",
            "fax_number": "229-388-0556"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SMITH",
        "first_name": "LISA",
        "middle_name": "DIAN",
        "name_prefix": "Mrs.",
        "credential": "FNP-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2013-09-04",
        "last_updated": "2013-09-04",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363L00000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner",
            "state": "GA",
            "license": "RN176448",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "LISA",
            "last_name": "MIXON",
            "middle_name": "DIAN",
            "prefix": "MISS",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Elizabeth Ellen Smith, APRN
• Eva Rose Smith, PA
• Kaitlyn Leigh Smith, NP-C
• Laquesha Larenda Smith, RN
• Latecia S Smith, NP
• Sara C Smith, M.D.
• Warren Stephen Smith, CRNA
• William Morgan Smith, MD
• Tina Marie Snow, LMT
• Vinod Kumar Reddy Solipuram

• Nurse Practitioner in Tifton, GA
• Providers in Tifton, GA by specialty
• Nurse Practitioner in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 4, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.