Provider Demographics
NPI:1578281390
Name:WILMETH, LISA CAROLIN (NP)
Entity Type:Individual
Prefix:
First Name:LISA
Middle Name:CAROLIN
Last Name:WILMETH
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:LISA
Other - Middle Name:CAROLIN
Other - Last Name:HENNING
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:706 FILLMORE ST
Mailing Address - Street 2:
Mailing Address - City:WICHITA FALLS
Mailing Address - State:TX
Mailing Address - Zip Code:76301-4013
Mailing Address - Country:US
Mailing Address - Phone:940-235-9743
Mailing Address - Fax:
Practice Address - Street 1:1202 SW 67TH ST
Practice Address - Street 2:
Practice Address - City:LAWTON
Practice Address - State:OK
Practice Address - Zip Code:73505-7437
Practice Address - Country:US
Practice Address - Phone:818-749-1203
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-08-17
Last Update Date:2022-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK209852363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily