Provider Demographics
NPI:1194965384
Name:CORLEY, LISA M (PA-C)
Entity type:Individual
Prefix:
First Name:LISA
Middle Name:M
Last Name:CORLEY
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3800 FALL WHEAT DR
Mailing Address - Street 2:
Mailing Address - City:PLANO
Mailing Address - State:TX
Mailing Address - Zip Code:75075-1510
Mailing Address - Country:US
Mailing Address - Phone:214-476-1049
Mailing Address - Fax:214-390-6236
Practice Address - Street 1:4323 N JOSEY LN
Practice Address - Street 2:
Practice Address - City:CARROLLTON
Practice Address - State:TX
Practice Address - Zip Code:75010-4633
Practice Address - Country:US
Practice Address - Phone:972-939-4646
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-02-27
Last Update Date:2010-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXPA02934363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical