Provider Demographics
NPI:1568619229
Name:BRITTMON, LISA (APN, FNP-BC)
Entity Type:Individual
Prefix:MRS
First Name:LISA
Middle Name:
Last Name:BRITTMON
Suffix:
Gender:F
Credentials:APN, FNP-BC
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 1908
Mailing Address - Street 2:
Mailing Address - City:GREENVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:75403-1908
Mailing Address - Country:US
Mailing Address - Phone:903-455-5986
Mailing Address - Fax:903-454-4621
Practice Address - Street 1:920 N CENTER ST
Practice Address - Street 2:
Practice Address - City:BONHAM
Practice Address - State:TX
Practice Address - Zip Code:75418-3751
Practice Address - Country:US
Practice Address - Phone:903-583-6155
Practice Address - Fax:903-583-3158
Is Sole Proprietor?:No
Enumeration Date:2008-08-25
Last Update Date:2014-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL209007220363LF0000X
TX797776363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL209007220OtherAPN LICENSE
TX797776OtherTEXAS NURSE PRACTITIONER LICENSE NUMBER