Lisa Ellard, CRNP

Key facts

NPI

1205934007

Entity type

Individual (NPI type 1)

Primary specialty

Family Nurse Practitioner 363LF0000X

License

157047 (AL)

Practice address

1890 Al Highway 157
Suite 300
Cullman, AL 35058-3601

Phone

(256) 737-8000

Fax

(256) 737-8058

NPI assigned

Sep 20, 2006

Sex

Female

Sole proprietor

No

Organizations & group practices 1

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.

• Cullman Internal Medicine, PC Internal Medicine Physician · Cullman, AL · NPI 1619920519
  Medicare reassignment NPD AL

Medicare participation

Medicare fee-for-service enrollment

Enrolled in AL

Eligible to order & refer

Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: Yes · Hospice: No

Medicare enrollment records

National Provider Directory

Medicare enrollment (NPD)

Yes

Credentials

Certified Registered Nurse, Nurse Practitioner

State licenses

Practice roles

Locations

Specialties & licenses

Addresses

Other identifiers

The complete NPPES record for this NPI in the NPI Registry API JSON format, last updated by the provider on Feb 14, 2012.

{
    "created_epoch": "1158710400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1329177600000",
    "number": "1205934007",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1890 AL HIGHWAY 157",
            "address_2": "SUITE 300",
            "city": "CULLMAN",
            "state": "AL",
            "postal_code": "350583601",
            "telephone_number": "256-737-8000",
            "fax_number": "256-737-8058"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1890 AL HIGHWAY 157",
            "address_2": "SUITE 300",
            "city": "CULLMAN",
            "state": "AL",
            "postal_code": "350583601",
            "telephone_number": "256-737-8000",
            "fax_number": "256-737-8058"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ELLARD",
        "first_name": "LISA",
        "credential": "CRNP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-09-20",
        "last_updated": "2012-02-14",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "AL",
            "license": "157047",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "000046973",
            "state": "AL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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All providers in Cullman, AL · Family Nurse Practitioner in Alabama