Healthcare Provider Details

I. General information

NPI: 1689057010
Provider Name (Legal Business Name): LISA KOTT-HARRINGTON FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: LISA MICHELLE OLSON

II. Dates (important events)

Enumeration Date: 07/02/2015
Last Update Date: 10/27/2020
Certification Date: 10/27/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1308 S STATE HIGHWAY 16
FREDERICKSBURG TX
78624-5058
US

IV. Provider business mailing address

1308 S STATE HIGHWAY 16
FREDERICKSBURG TX
78624-5058
US

V. Phone/Fax

Practice location:
  • Phone: 830-997-2181
  • Fax: 830-997-4453
Mailing address:
  • Phone: 830-997-2181
  • Fax: 830-997-4453

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAP128417
License Number StateTX
# 2
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberAP128417
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: