Provider Demographics
NPI:1922171628
Name:MAHLER, LISA ANN (FNP-C)
Entity Type:Individual
Prefix:
First Name:LISA
Middle Name:ANN
Last Name:MAHLER
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:PO BOX 474
Mailing Address - Street 2:
Mailing Address - City:WHEELER
Mailing Address - State:TX
Mailing Address - Zip Code:79096-0474
Mailing Address - Country:US
Mailing Address - Phone:806-216-0256
Mailing Address - Fax:
Practice Address - Street 1:5211 SW 9TH AVE
Practice Address - Street 2:
Practice Address - City:AMARILLO
Practice Address - State:TX
Practice Address - Zip Code:79106-4120
Practice Address - Country:US
Practice Address - Phone:806-356-0026
Practice Address - Fax:806-826-0185
Is Sole Proprietor?:No
Enumeration Date:2006-11-17
Last Update Date:2021-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAP115438363LF0000X
TX572707363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
OKQ75759Medicare UPIN
OKOKA106026Medicare PIN