Provider Demographics
NPI:1881581825
Name:BYNUM, LISA L (RN)
Entity type:Individual
Prefix:
First Name:LISA
Middle Name:L
Last Name:BYNUM
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:615 N STATE OF FRANKLIN RD
Mailing Address - Street 2:
Mailing Address - City:JOHNSON CITY
Mailing Address - State:TN
Mailing Address - Zip Code:37604-8209
Mailing Address - Country:US
Mailing Address - Phone:423-930-8337
Mailing Address - Fax:423-926-1047
Practice Address - Street 1:615 N STATE OF FRANKLIN RD
Practice Address - Street 2:
Practice Address - City:JOHNSON CITY
Practice Address - State:TN
Practice Address - Zip Code:37604-8209
Practice Address - Country:US
Practice Address - Phone:423-930-8337
Practice Address - Fax:423-926-1047
Is Sole Proprietor?:No
Enumeration Date:2025-06-23
Last Update Date:2025-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN173342163WA2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WA2000XNursing Service ProvidersRegistered NurseAdministrator