Provider Demographics
NPI:1124128806
Name:ELLIOTT, LISA ANN (WHNP-RX AUTH)
Entity type:Individual
Prefix:
First Name:LISA
Middle Name:ANN
Last Name:ELLIOTT
Suffix:
Gender:F
Credentials:WHNP-RX AUTH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 650859
Mailing Address - Street 2:DEPT 710
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75265-2515
Mailing Address - Country:US
Mailing Address - Phone:409-747-6240
Mailing Address - Fax:713-984-6525
Practice Address - Street 1:3737 RED BLUFF RD STE 150
Practice Address - Street 2:
Practice Address - City:PASADENA
Practice Address - State:TX
Practice Address - Zip Code:77503-3307
Practice Address - Country:US
Practice Address - Phone:409-266-1888
Practice Address - Fax:713-473-7160
Is Sole Proprietor?:No
Enumeration Date:2006-09-23
Last Update Date:2022-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX610412363LX0001X
TXAP109107363LW0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's Health
No363LX0001XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX8G4540Medicare ID - Type UnspecifiedINDIVIDUAL NUMBER