Provider Demographics
NPI:1174639595
Name:ALLEN, LISA M (PA-C)
Entity Type:Individual
Prefix:MS
First Name:LISA
Middle Name:M
Last Name:ALLEN
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:PO BOX 119
Mailing Address - Street 2:
Mailing Address - City:SUDAN
Mailing Address - State:TX
Mailing Address - Zip Code:79371-0119
Mailing Address - Country:US
Mailing Address - Phone:806-227-2292
Mailing Address - Fax:806-227-2293
Practice Address - Street 1:408 E US HWY 84
Practice Address - Street 2:
Practice Address - City:SUDAN
Practice Address - State:TX
Practice Address - Zip Code:79371
Practice Address - Country:US
Practice Address - Phone:806-227-2292
Practice Address - Fax:806-227-2293
Is Sole Proprietor?:No
Enumeration Date:2006-08-21
Last Update Date:2022-05-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXPA02006363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX8N9892OtherBCBS
TX8F2008Medicare ID - Type Unspecified
TX8N9892OtherBCBS