Provider Demographics
NPI:1598222309
Name:CHURCH, LISA LYNEE (FNP, PMHNP)
Entity Type:Individual
Prefix:
First Name:LISA
Middle Name:LYNEE
Last Name:CHURCH
Suffix:
Gender:F
Credentials:FNP, PMHNP
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 372
Mailing Address - Street 2:
Mailing Address - City:LEXINGTON
Mailing Address - State:TX
Mailing Address - Zip Code:78947-0372
Mailing Address - Country:US
Mailing Address - Phone:281-433-4815
Mailing Address - Fax:
Practice Address - Street 1:711 N COLLEGE ST
Practice Address - Street 2:
Practice Address - City:GEORGETOWN
Practice Address - State:TX
Practice Address - Zip Code:78626-4105
Practice Address - Country:US
Practice Address - Phone:512-869-2650
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-02-28
Last Update Date:2023-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAP140779363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily