Healthcare Provider Details

I. General information

NPI: 1568619229
Provider Name (Legal Business Name): LISA BRITTMON APN, FNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/25/2008
Last Update Date: 09/10/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

920 N CENTER ST
BONHAM TX
75418-3751
US

IV. Provider business mailing address

PO BOX 1908
GREENVILLE TX
75403-1908
US

V. Phone/Fax

Practice location:
  • Phone: 903-583-6155
  • Fax: 903-583-3158
Mailing address:
  • Phone: 903-455-5986
  • Fax: 903-454-4621

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number209007220
License Number StateIL
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number797776
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: