Provider Demographics
NPI:1114815834
Name:MATHERLY, LISA P
Entity type:Individual
Prefix:
First Name:LISA
Middle Name:P
Last Name:MATHERLY
Suffix:
Gender:X
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:165 ELLISON RIDGE RD
Mailing Address - Street 2:
Mailing Address - City:FLAT TOP
Mailing Address - State:WV
Mailing Address - Zip Code:25841-7726
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:165 ELLISON RIDGE RD
Practice Address - Street 2:
Practice Address - City:FLAT TOP
Practice Address - State:WV
Practice Address - Zip Code:25841-7726
Practice Address - Country:US
Practice Address - Phone:304-573-1559
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-06-24
Last Update Date:2025-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide