Healthcare Provider Details

I. General information

NPI: 1174795918
Provider Name (Legal Business Name): LISA BRINSON FELL AUD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/01/2008
Last Update Date: 04/10/2020
Certification Date: 04/10/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1261 W GREEN OAKS BLVD SUITE 105
ARLINGTON TX
76013-8348
US

IV. Provider business mailing address

1261 W GREEN OAKS BLVD SUITE 105
ARLINGTON TX
76013-8348
US

V. Phone/Fax

Practice location:
  • Phone: 817-451-4818
  • Fax: 817-451-4828
Mailing address:
  • Phone: 817-451-4818
  • Fax: 817-451-4828

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code237600000X
TaxonomyAudiologist-Hearing Aid Fitter
License Number51301
License Number StateTX
# 2
Primary TaxonomyY
Taxonomy Code231H00000X
TaxonomyAudiologist
License Number51301
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: