Provider Demographics
NPI:1336833441
Name:WILLIAMS, LISA RENEE (AGACNP-BC)
Entity Type:Individual
Prefix:
First Name:LISA
Middle Name:RENEE
Last Name:WILLIAMS
Suffix:
Gender:F
Credentials:AGACNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11586 GATESVILLE DR
Mailing Address - Street 2:
Mailing Address - City:FRISCO
Mailing Address - State:TX
Mailing Address - Zip Code:75035-9144
Mailing Address - Country:US
Mailing Address - Phone:214-457-4911
Mailing Address - Fax:
Practice Address - Street 1:6000 HARRY HINES BLVD STE ND2.300
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75235-5303
Practice Address - Country:US
Practice Address - Phone:817-825-6628
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-06-05
Last Update Date:2023-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1099132207RH0000X, 363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No207RH0000XAllopathic & Osteopathic PhysiciansInternal MedicineHematology