Healthcare Provider Details

I. General information

NPI: 1235135567
Provider Name (Legal Business Name): LISA G TAYLOR RN, CNS, FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/22/2005
Last Update Date: 01/22/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

135 N FALLING LEAVES DR
WAXAHACHIE TX
75167-9045
US

IV. Provider business mailing address

135 N FALLING LEAVES DR
WAXAHACHIE TX
75167-9045
US

V. Phone/Fax

Practice location:
  • Phone: 214-564-6354
  • Fax: 972-938-1681
Mailing address:
  • Phone: 972-938-1674
  • Fax: 972-938-1681

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code364SC1501X
TaxonomyCommunity Health/Public Health Clinical Nurse Specialist
License NumberAP106105
License Number StateTX
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAP106105
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: