Lisa Lanette Jackson, APN
Individual provider Active NPI Family Nurse Practitioner · Lewisville, AR
NPI 1497828826 · NPPES record last updated May 29, 2015
Key facts
- NPI
- 1497828826
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Family Nurse Practitioner 363LF0000X
- License
- A02932 ANP (AR)
- Practice address
- 1117 Chestnut St
Lewisville, AR 71845 - Phone
- (870) 921-5781
- Fax
- (870) 798-4100
- NPI assigned
- Nov 15, 2006
- Sex
- Female
- Sole proprietor
- Yes
Organizations & group practices 3
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled (2 enrollments) in AR, LA
- 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 |
|---|---|---|---|---|
| I20070430000557 | AR | Practitioner - Nurse Practitioner | 2961508486 | Reassigns benefits to 1 organization |
| I20190402000600 | LA | Practitioner - Nurse Practitioner | 2961508486 | Reassigns benefits to 1 organization |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Nurse Practitioner
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| A02932 ANP | AR | MD | Family Nurse Practitioner |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Cabun Rural Health Services, Inc | Current |
Accepting new patients | |
| Curana Health of Louisiana LLC | Current |
Accepting new patients | |
| Cabun Rural Health Services, Inc. | Current | Accepting new patients |
Locations
1117 Chestnut St
Lewisville, AR 71845
Phone (870) 921-5781
2900 Westfork Dr
Ste 401
Baton Rouge, LA 70827
Phone (225) 953-0895
1509 Dulles Dr
Lafayette, LA 70506
Phone (337) 408-0803
Interoperability endpoints
- https://fhir.nextgen.com/nge/prod/fhir-api-r4/fhir/r4/
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Family Nurse Practitioner | 363LF0000X | A02932 ANP | AR | Yes |
Addresses
Primary practice location
1117 Chestnut St
Lewisville, AR 71845
Mailing address
1117 Chestnut
Lewisville, AR 71845-1117
Phone (870) 921-5781
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 202614758 | Medicaid | AR |
Other names
- Ms. Lisa Lanette Smith
Other providers in Lewisville, AR
- Megan Malyn Cullipher
- Shyia Ellingburg
- Chevon Yvette Garrard
- Cassandra Lacole Henry
- Alisha W. Howell
- Katherine Sue Kee
- Wendy Jo Kelton
- Pamela Kirkpatrick
- Lafayette County Ambulance Service Inc.
- Lafayette County Family Practice
All providers in Lewisville, AR · Family Nurse Practitioner in Arkansas
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on May 29, 2015. 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.