Provider Demographics
NPI:1265904411
Name:TRAWICK, LISA KATHRYN (NP)
Entity type:Individual
Prefix:
First Name:LISA
Middle Name:KATHRYN
Last Name:TRAWICK
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1325 N DICKINSON DR
Mailing Address - Street 2:
Mailing Address - City:RUSK
Mailing Address - State:TX
Mailing Address - Zip Code:75785-1051
Mailing Address - Country:US
Mailing Address - Phone:903-683-5555
Mailing Address - Fax:
Practice Address - Street 1:1325 N DICKINSON DR
Practice Address - Street 2:
Practice Address - City:RUSK
Practice Address - State:TX
Practice Address - Zip Code:75785-1051
Practice Address - Country:US
Practice Address - Phone:903-683-5555
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-12-28
Last Update Date:2018-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAP140073363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily