Provider Demographics
NPI:1457826596
Name:LISLE, RACHEL
Entity Type:Individual
Prefix:
First Name:RACHEL
Middle Name:
Last Name:LISLE
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 1:4020 N MACARTHUR BLVD STE 122
Mailing Address - Street 2:
Mailing Address - City:IRVING
Mailing Address - State:TX
Mailing Address - Zip Code:75038-6422
Mailing Address - Country:US
Mailing Address - Phone:972-922-6167
Mailing Address - Fax:
Practice Address - Street 1:4020 N MACARTHUR BLVD STE 122
Practice Address - Street 2:PMB 1110
Practice Address - City:IRVING
Practice Address - State:TX
Practice Address - Zip Code:75038-6422
Practice Address - Country:US
Practice Address - Phone:972-922-6167
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-10-04
Last Update Date:2022-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAP139094363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily