Lisa Connelly, FNP-C
Individual provider Active NPI Family Nurse Practitioner · Emporia, KS
NPI 1710428461 · NPPES record last updated Apr 17, 2018
Key facts
- NPI
- 1710428461
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Family Nurse Practitioner 363LF0000X
- License
- 77645 (KS)
- Practice address
- 420 W 15TH Ave
Emporia, KS 66801-5367 - Phone
- (620) 251-2400
- Fax
- (620) 251-1619
- NPI assigned
- Mar 14, 2017
- Sex
- Female
- Sole proprietor
- No
Organizations & group practices 5
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled (2 enrollments) in KS, OK
- 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 |
|---|---|---|---|---|
| I20170712002073 | KS | Practitioner - Nurse Practitioner | 6901175694 | Reassigns benefits to 1 organization |
| I20250723000124 | OK | Practitioner - Nurse Practitioner | 6901175694 | Reassigns benefits to 1 organization |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Nurse Practitioner
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 77645 | KS | MD | Family Nurse Practitioner |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Coffeyville Regional Medical Center, Inc. | Current |
Accepting new patients | |
| Altea Medical Oklahoma PLLC | Current |
Accepting new patients | |
| Coffeyville Regional Medical Center Inc | Current |
Accepting new patients | |
| Tomorrow'S Technology Today | Past | Accepting new patients | |
| Coffeyville Regional Medical Center, Inc | Past | Accepting new patients |
Locations
400 E Rivulon Blvd
Ste 103
Gilbert, AZ 85297
1400 W 4th St
Coffeyville, KS 67337
Phone (620) 251-1200
9905 S Pennsylvania Ave
Ste A
Oklahoma City, OK 73159
Phone (405) 394-5298
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Family Nurse Practitioner | 363LF0000X | 77645 | KS | Yes |
Addresses
Primary practice location
420 W 15TH Ave
Emporia, KS 66801-5367
Mailing address
1505 W 4TH St
Coffeyville, KS 67337-3307
Phone (620) 251-2400
Other providers in Emporia, KS
- Common Ground Mental Wellness, LLC
- Community Connections
- Community Healthcare Collective Inc
- Verlin Conkle
- Mary Ellen Conley
- Jerry L. Conrade
- Joseph Patrick Conroy
- Janice Leann Cook
- Bethany L. Cooper
- Chloe Cope
All providers in Emporia, KS · Family Nurse Practitioner in Kansas
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Apr 17, 2018. 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.