Lisa Dunivan King, NP

Primary specialty

Family Nurse PractitionerTaxonomy code 363LF0000X

License

28972 Issued in TN

Practice address

1605 S Highland Ave
Jackson, TN 38301-7718

Phone

(731) 424-9741

Fax

(731) 427-5241

NPI assigned

Aug 2, 2021

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

Medicare fee-for-service enrollment

Enrolled in TN

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

Credentials

Master of Science - Nursing, Nurse Practitioner

State licenses

Practice roles

Locations

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.

• Christian Family Medicine, LLC

  • Family Medicine Physician
  • Ripley, TN
  • NPI 1043252620

  TN

  Medicare reassignment Care Compare group NPD
• Christian Family Medicine

  • Family Nurse Practitioner
  • Ripley, TN
  • NPI 1720338833

  Family

  NPD
• Independent Radiology Associates PLC

  • Diagnostic Radiology Physician
  • Dyersburg, TN
  • NPI 1194804906
  NPD (past)

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

• Bolivar General Hospital, Inc.

  • Critical Access Hospital
  • Bolivar, TN
  • NPI 1518957950

  Hospital

  Care Compare affiliation
• Jackson Madison County General Hospital

  • General Acute Care Hospital
  • Jackson, TN
  • NPI 1093705428

  Hospital

  Care Compare affiliation

Specialty

Nurse Practitioner

Education

Other, 2019

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Christian Family Medicine, LLC 33 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Jackson-Madison County General Hospital Hospital, Jackson, TN, CCN 440002
• West Tennessee Healthcare Bolivar Hospital Hospital, Bolivar, TN, CCN 441320

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

{
    "created_epoch": "1627862400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1627862400000",
    "number": "1407520786",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "375 PEDDY VESTAL LOOP",
            "city": "HENDERSON",
            "state": "TN",
            "postal_code": "383403492",
            "telephone_number": "731-695-4439"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1605 S HIGHLAND AVE",
            "city": "JACKSON",
            "state": "TN",
            "postal_code": "383017718",
            "telephone_number": "731-424-9741",
            "fax_number": "731-427-5241"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KING",
        "first_name": "LISA",
        "middle_name": "DUNIVAN",
        "credential": "NP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2021-08-02",
        "last_updated": "2021-08-02",
        "certification_date": "2021-07-01",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "TN",
            "license": "28972",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Kimberly Ann Kindle, PTA
• Amy Renee' King, OTR/L
• Emily King, MS
• Ericka King
• Kristin King, OD
• Lisa Michelle King, PHARMD
• Michael Wayne King, D.D.S.
• Shelley Dawn King
• Sonya Renai King, RN
• Kings & Queens LLC

• All providers in Jackson, TN
• Family Nurse Practitioner in Tennessee

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 2, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.