Lisa Yvonne Bradshaw-Small, APRN, BC

Primary specialty

Family Nurse PractitionerTaxonomy code 363LF0000X

License

RN141141 Issued in GA

Practice address

6269 Greenock Dr
Stone Mountain, GA 30087-6081

Phone

(404) 819-9665

Fax

(678) 825-6030

NPI assigned

Mar 30, 2007

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Nurse Practitioner

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Premier Personal Health Services, LLC

  • Home Health Agency
  • Palmetto, GA
  • NPI 1205100591
  NPD (past) Authorized official
• Premier Personal Health Services, LLC

  • Nursing Care Agency
  • Stone Mountain, GA
  • NPI 1821354630
  NPD (past) Authorized official

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

{
    "created_epoch": "1175212800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1333584000000",
    "number": "1043330301",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6269 GREENOCK DR",
            "city": "STONE MOUNTAIN",
            "state": "GA",
            "postal_code": "300876081",
            "telephone_number": "404-819-9665",
            "fax_number": "678-825-6030"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6269 GREENOCK DR",
            "city": "STONE MOUNTAIN",
            "state": "GA",
            "postal_code": "300876081",
            "telephone_number": "404-819-9665",
            "fax_number": "678-825-6030"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BRADSHAW-SMALL",
        "first_name": "LISA",
        "middle_name": "YVONNE",
        "name_prefix": "Mrs.",
        "credential": "APRN, BC",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2007-03-30",
        "last_updated": "2012-04-05",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "163WP0809X",
            "taxonomy_group": "",
            "desc": "Registered Nurse, Psychiatric/Mental Health, Adult",
            "state": "GA",
            "license": "RN141141",
            "primary": false
        },
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "GA",
            "license": "RN141141",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Monica Ashraf Boulis
• Garry Blake Bowden, M.D.
• John W Boyer, D.C.
• Theron Boykin
• Shannon Brabham
• Precious A Brannon, PHD
• Sandra Juliana Bravo-Patino, LCSW
• Bridgepoint Homecare Agency
• Patrice Bridges, REGISTERED NURSE
• Bridgewell Alliance, LLC

• Family Nurse Practitioner in Stone Mountain, GA
• Providers in Stone Mountain, GA by specialty
• Family Nurse Practitioner in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 5, 2012; 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.