Individual provider Active NPI

Lisa Chandler Davis, PA-C

  • Physician Assistant
  • Raleigh, NC
National Provider Identifier
1326167925
Registry record updated Jan 29, 2009
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
102668 Issued in NC
Practice address
3521 Haworth Dr
Raleigh, NC 27609-7216
Phone
(919) 782-1806
Fax
(919) 782-4756
NPI assigned
Mar 28, 2007
Last updated
Jan 29, 2009By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jan 29, 2009

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physician Assistant 363A00000X 102668 NC Primary

Addresses

Primary practice location

3521 Haworth Dr
Raleigh, NC 27609-7216

Mailing address

PO Box 18563
Raleigh, NC 27619-8563
Phone (919) 782-1806

Other identifiers 1

IdentifierTypeStateIssuer
970018198OtherRAILROAD MEDICARE

Other names 1

  • M Lisa Roy Former name

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Physician Assistant

State licenses

LicenseStateTypeSpecialty
102668NCMDPhysician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Rex Hospital, Inc. Past Accepting new patients

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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

NPI Registry JSON

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

{
    "created_epoch": "1175040000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1233187200000",
    "number": "1326167925",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 18563",
            "city": "RALEIGH",
            "state": "NC",
            "postal_code": "276198563",
            "telephone_number": "919-782-1806",
            "fax_number": "919-782-1669"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3521 HAWORTH DR",
            "city": "RALEIGH",
            "state": "NC",
            "postal_code": "276097216",
            "telephone_number": "919-782-1806",
            "fax_number": "919-782-4756"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DAVIS",
        "first_name": "LISA",
        "middle_name": "CHANDLER",
        "name_prefix": "Mrs.",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2007-03-28",
        "last_updated": "2009-01-29",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "NC",
            "license": "102668",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RAILROAD MEDICARE",
            "identifier": "970018198",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "M",
            "last_name": "ROY",
            "middle_name": "LISA",
            "credential": "PA-C",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

Other providers in Raleigh, NC

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 29, 2009; 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.