Provider Demographics
NPI:1184270035
Name:JENNEY, LISA
Entity type:Individual
Prefix:
First Name:LISA
Middle Name:
Last Name:JENNEY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:572 COLEMAN ST
Mailing Address - Street 2:
Mailing Address - City:WAXAHACHIE
Mailing Address - State:TX
Mailing Address - Zip Code:75165-2837
Mailing Address - Country:US
Mailing Address - Phone:972-923-2440
Mailing Address - Fax:972-923-2445
Practice Address - Street 1:572 COLEMAN ST
Practice Address - Street 2:
Practice Address - City:WAXAHACHIE
Practice Address - State:TX
Practice Address - Zip Code:75165-2837
Practice Address - Country:US
Practice Address - Phone:972-923-2440
Practice Address - Fax:972-923-2445
Is Sole Proprietor?:No
Enumeration Date:2019-08-15
Last Update Date:2025-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAAP60983700363LF0000X
TX1010656363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily