Provider Demographics
NPI:1639615263
Name:PAMPLIN, LISA (FNP-C)
Entity Type:Individual
Prefix:
First Name:LISA
Middle Name:
Last Name:PAMPLIN
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6946 GENTLE BREEZE DR
Mailing Address - Street 2:
Mailing Address - City:WILLIS
Mailing Address - State:TX
Mailing Address - Zip Code:77318-9179
Mailing Address - Country:US
Mailing Address - Phone:936-443-5675
Mailing Address - Fax:
Practice Address - Street 1:6946 GENTLE BREEZE DR
Practice Address - Street 2:
Practice Address - City:WILLIS
Practice Address - State:TX
Practice Address - Zip Code:77318-9179
Practice Address - Country:US
Practice Address - Phone:936-443-5675
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-01-06
Last Update Date:2017-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAP132942363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily