Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.

Lisa Marie Park, FNP-BC

Individual provider Family Medicine Physician · NPI 1639944382

Lisa Marie Park, FNP-BC is a Nurse Practitioner in Triadelphia, West Virginia. Qualified in 2023, 3 years ago. Practices with Wmc Physician Practices LLC, a 111-clinician group and accepts Medicare assignment. Licensed in West Virginia.

Years since qualifying
3
Licensed in
WV
In the registry since
2023
What do these letters mean?
FNP-BC — Family Nurse Practitioner, Board Certified
A family nurse practitioner certified by the ANCC.

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Practice location Address checks out

4509 National Rd
Triadelphia, WV 26059-2013
Phone: (304) 639-0873
Show map & directions

Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Family Medicine Physician (primary) Taxonomy 207Q00000X · Licence 117804 (WV)

Record details

NPI number1639944382
Entity typeIndividual (Type 1)
GenderFemale
Credentials FNP-BC
Sole proprietorYes
NPI enumeratedNovember 21, 2023
Last updated in NPPESNovember 21, 2023
Certification dateOctober 25, 2023

Medicare enrollment

From the CMS Doctors & Clinicians file — this clinician is enrolled in Medicare.

Medicare specialtyNURSE PRACTITIONER
Medical schoolOTHER
Graduated 2023 (3 years in practice)
Group practice Wmc Physician Practices Llc — 111 clinicians
Accepts Medicare assignment Yes — accepts the Medicare-approved amount