MEDICARE: LISA HOLIDAY HARMON FNP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LF0000X	Family Nurse Practitioner	AP130367	TX

General Provider Information

NPI Number	:	1376902023
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LISA HOLIDAY HARMON FNP

Provider Business Mailing Address
First Line	:	16300 KUYKENDAHL RD STE 410
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77068-2751
Country	:	US
Telephone Number	:	832-666-7974
Fax Number	:

Provider Business Practice Location Address
First Line	:	17007 DAWN SHADOWS DR
Second Line	:
City	:	HUMBLE
State	:	TX
Zip	:	77346-4547
Country	:	US
Telephone Number	:	832-643-9116
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/22/2016
Last Update Date	:	03/30/2018

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