Provider Demographics
NPI:1689057010
Name:KOTT-HARRINGTON, LISA (FNP-C)
Entity Type:Individual
Prefix:
First Name:LISA
Middle Name:
Last Name:KOTT-HARRINGTON
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:LISA
Other - Middle Name:MICHELLE
Other - Last Name:OLSON
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:1308 S STATE HIGHWAY 16
Mailing Address - Street 2:
Mailing Address - City:FREDERICKSBURG
Mailing Address - State:TX
Mailing Address - Zip Code:78624-5058
Mailing Address - Country:US
Mailing Address - Phone:830-997-2181
Mailing Address - Fax:830-997-4453
Practice Address - Street 1:1308 S STATE HIGHWAY 16
Practice Address - Street 2:
Practice Address - City:FREDERICKSBURG
Practice Address - State:TX
Practice Address - Zip Code:78624-5058
Practice Address - Country:US
Practice Address - Phone:830-997-2181
Practice Address - Fax:830-997-4453
Is Sole Proprietor?:No
Enumeration Date:2015-07-02
Last Update Date:2020-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAP128417363LF0000X, 363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX357537504Medicaid