Lisa Ousley, DNP
Individual provider Active NPI Family Nurse Practitioner · Johnson City, TN
NPI 1033214739 · NPPES record last updated May 3, 2017
Key facts
- NPI
- 1033214739
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Family Nurse Practitioner 363LF0000X
- License
- 0000015032 (TN)
- Practice address
- 365 Stout Dr. Suite 160
Johnson City, TN 37614-1709 - Phone
- (423) 929-2930
- NPI assigned
- Sep 14, 2006
- Sex
- Female
- Sole proprietor
- No
Organizations & group practices 4
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in GA
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: Yes · Hospice: No
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20211209001809 | GA | Practitioner - Nurse Practitioner | 4385784925 | Reassigns benefits to 1 organization |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Nurse Practitioner
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 15032 | TN | MD | Physical Therapist |
| 24000013 | VA | MD | Nurse Practitioner |
| 0000015032 | TN | MD | Family Nurse Practitioner |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| My Doctors Clinic LLC | Current |
Accepting new patients | |
| Twin County Family Care Centers Inc | Past | Accepting new patients | |
| Hank Clay Jr MD PC | Past | Accepting new patients | |
| Watauga Lake Family Medicine PC | Past | Accepting new patients |
Locations
2320 Atlanta Hwy
Ste 105
Cumming, GA 30040
Phone (678) 473-0715
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Nurse Practitioner | 363L00000X | 24000013 | VA | |
| Family Nurse Practitioner | 363LF0000X | 0000015032 | TN | Yes |
Addresses
Primary practice location
365 Stout Dr. Suite 160
Johnson City, TN 37614-1709
Mailing address
365 Stout Drive
Johnson City, TN 37601-4824
Phone (423) 929-2930
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 007786093 | Medicaid | VA | |
| 1522794 | Medicaid | TN |
Other providers in Johnson City, TN
- Jennifer Osher
- Maria Osipovich
- Michael Ostapchuk
- James Milton Otis
- Deanna Marie Ottinger
- Michaela Ann Outlaw
- Outpatient Cytopathology Center
- Outreach Clinics Unlimited PLLC
- Carolyn H. Overbay
- Paige B Overton
All providers in Johnson City, TN · Family Nurse Practitioner in Tennessee
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on May 3, 2017. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.