Healthcare Provider Details

I. General information

NPI: 1962805028
Provider Name (Legal Business Name): LISA CRANE PMHNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/03/2014
Last Update Date: 10/17/2025
Certification Date: 10/17/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3841 MIDWAY PL NE
ALBUQUERQUE NM
87109-5814
US

IV. Provider business mailing address

13451 STONE VIEW DR
AMARILLO TX
79124-4681
US

V. Phone/Fax

Practice location:
  • Phone: 505-429-1792
  • Fax:
Mailing address:
  • Phone: 575-708-1438
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number1123009
License Number StateTX
# 2
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberCNP-02650
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: