MEDICARE: LISA CRANE PMHNP-BC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LP0808X	Psychiatric/Mental Health Nurse Practitioner	1123009	TX
2	207Q00000X	Family Medicine Physician	CNP-02650	NM

General Provider Information

NPI Number	:	1962805028
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LISA CRANE PMHNP-BC

Provider Business Mailing Address
First Line	:	13451 STONE VIEW DR
Second Line	:
City	:	AMARILLO
State	:	TX
Zip	:	79124-4681
Country	:	US
Telephone Number	:	575-708-1438
Fax Number	:

Provider Business Practice Location Address
First Line	:	3841 MIDWAY PL NE
Second Line	:
City	:	ALBUQUERQUE
State	:	NM
Zip	:	87109-5814
Country	:	US
Telephone Number	:	505-429-1792
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/03/2014
Last Update Date	:	10/17/2025

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