Healthcare Provider Details

I. General information

NPI: 1871004101
Provider Name (Legal Business Name): LISSY JOSEPH FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/13/2017
Last Update Date: 09/02/2026
Certification Date: 09/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14111 KING RD STE 320
FRISCO TX
75036-0810
US

IV. Provider business mailing address

14111 KING RD STE 320
FRISCO TX
75036-0810
US

V. Phone/Fax

Practice location:
  • Phone: 469-888-4890
  • Fax:
Mailing address:
  • Phone: 469-888-4890
  • Fax: 866-292-0929

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberAP134674
License Number StateTX
# 2
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberAP134674
License Number StateTX
# 3
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAP134674
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: