| Doctor Name: | MS. LISA COX REARDON |
| NPI Number: | 1407890130 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | M.ED |
| License Number: | 1183 |
| Business Practice Address: | 307 North Castleman Street Oak Grove, LA - 712630788 |
| Business Phone Number: | 3184283249 |
| Business Fax Number: | 3184287547 |
| Mailing Address: | Po Box 761, 1627 Skinner Lane OAK GROVE |
| State: | LA |
| Postal Code: | 712630761 |
| Phone Number: | 3184283249 |
| Fax Number: | 3184287547 |
| NPI Enumeration Date: | 06/15/2006 |
| NPI Last Update Date: | 07/08/2007 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 376G00000X |
| License Number: | 1183 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | LA |
| Taxonomy Type: | Nursing Service Related Providers |
| Taxonomy Classification: | Nursing Home Administrator |
| Taxonomy Specialization: | |
| Taxonomy Definition: | An individual, often licensed by the state, who is responsible for the management of a nursing home. |