1568619229 NPI number — MRS. LISA BRITTMON APN, FNP-BC

Table of content: MRS. LISA BRITTMON APN, FNP-BC (NPI 1568619229)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1568619229 NPI number — MRS. LISA BRITTMON APN, FNP-BC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
BRITTMON
Provider First Name:
LISA
Provider Middle Name:
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
APN, FNP-BC
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1568619229
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
09/10/2014
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 1908
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
GREENVILLE
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
75403-1908
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
903-455-5986
Provider Business Mailing Address Fax Number:
903-454-4621

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
920 N CENTER ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BONHAM
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
75418-3751
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
903-583-6155
Provider Business Practice Location Address Fax Number:
903-583-3158
Provider Enumeration Date:
08/25/2008

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 363LF0000X , with the licence number:  209007220 , registered in the state of IL ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 363LF0000X , with the licence number: 797776 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 209007220 . This is a "APN LICENSE" identifier , issued by the state of ( IL ) . This identifiers is of the category "OTHER".
  • Identifier: 797776 . This is a "TEXAS NURSE PRACTITIONER LICENSE NUMBER" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".




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