Healthcare Provider Details

I. General information

NPI: 1154363265
Provider Name (Legal Business Name): LISA ANN HESTER MILLER PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MISS LISA ANN HESTER

II. Dates (important events)

Enumeration Date: 06/12/2006
Last Update Date: 04/01/2020
Certification Date: 04/01/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2300 VALLEY VIEW LN STE 330
IRVING TX
75062-1736
US

IV. Provider business mailing address

819 N BROADWAY ST
ASPERMONT TX
79502-2029
US

V. Phone/Fax

Practice location:
  • Phone: 713-850-0049
  • Fax: 713-627-7302
Mailing address:
  • Phone: 940-989-3551
  • Fax: 940-989-3395

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA00490
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: