Active NPI
Lisa M Williams, NP
- Nurse Practitioner
- Provo, UT
National Provider Identifier
1831243971
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Nurse Practitioner
- License
- 5328015-4405
- Practice address
- 1055 N 500 W
Suite 111
Provo, UT 84604-3305 - Phone
- (801) 374-8999
- Fax
- (801) 429-8063
- NPI assigned
- Jan 23, 2007
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Nurse Practitioner | 363L00000X | 5328015-4405 | UT | Primary |
Addresses
Primary practice location
1055 N 500 W
Suite 111
Provo, UT 84604-3305
Mailing address
1055 N 500 W
Credentialing Department
Provo, UT 84604-3305
Phone (801) 354-8225
Other names 1
- Lisa M Whitaker
Electronic endpoints 1
| Type | Endpoint | Use | Affiliation |
|---|---|---|---|
| Direct Messaging Address | medreview@reverehealth.com | Revere Health PC |
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
- Nurse Practitioner
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1169510400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1701043200000",
"number": "1831243971",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1055 N 500 W",
"address_2": "CREDENTIALING DEPARTMENT",
"city": "PROVO",
"state": "UT",
"postal_code": "846043305",
"telephone_number": "801-354-8225",
"fax_number": "801-418-0941"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1055 N 500 W",
"address_2": "SUITE 111",
"city": "PROVO",
"state": "UT",
"postal_code": "846043305",
"telephone_number": "801-374-8999",
"fax_number": "801-429-8063"
}
],
"practiceLocations": [],
"basic": {
"last_name": "WILLIAMS",
"first_name": "LISA",
"middle_name": "M",
"credential": "NP",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2007-01-23",
"last_updated": "2023-11-27",
"certification_date": "2020-03-04",
"status": "A"
},
"taxonomies": [
{
"code": "363L00000X",
"taxonomy_group": "",
"desc": "Nurse Practitioner",
"state": "UT",
"license": "5328015-4405",
"primary": true
}
],
"identifiers": [],
"endpoints": [
{
"endpointType": "DIRECT",
"endpointTypeDescription": "Direct Messaging Address",
"endpoint": "medreview@reverehealth.com",
"affiliation": "Y",
"affiliationName": "Revere Health PC",
"address_1": "1055 N 500 W",
"address_2": "Suite 111",
"city": "Provo",
"state": "UT",
"country_code": "US",
"postal_code": "846043305",
"country_name": "United States",
"address_type": "DOM"
}
],
"other_names": [
{
"first_name": "LISA",
"last_name": "WHITAKER",
"middle_name": "M",
"credential": "NP",
"code": "1",
"type": "Former Name"
}
]
}Other providers in Provo, UT
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 27, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.