Healthcare Provider Details

I. General information

NPI: 1780094490
Provider Name (Legal Business Name): LISA CAROL BEAVER FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/02/2014
Last Update Date: 08/14/2026
Certification Date: 08/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2021 GUADALUPE ST STE 260
AUSTIN TX
78705-5654
US

IV. Provider business mailing address

2209 CANYON VALLEY TRAIL
PLANO TX
75023
US

V. Phone/Fax

Practice location:
  • Phone: 657-500-0634
  • Fax:
Mailing address:
  • Phone: 740-391-3025
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number15638
License Number StateOH
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAP132550
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: