Provider Demographics
NPI:1437695863
Name:WILKINS, LISA GAIL (AGNP)
Entity type:Individual
Prefix:MS
First Name:LISA
Middle Name:GAIL
Last Name:WILKINS
Suffix:
Gender:F
Credentials:AGNP
Other - Prefix:
Other - First Name:LISA
Other - Middle Name:GAIL
Other - Last Name:MONTGOMERY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:AGNP
Mailing Address - Street 1:1411 N. BECKLEY AVE.
Mailing Address - Street 2:PAVILION III SUITE 152
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75203
Mailing Address - Country:US
Mailing Address - Phone:214-948-2076
Mailing Address - Fax:214-948-9990
Practice Address - Street 1:1411 N BECKLEY AVE
Practice Address - Street 2:PAVILION III, SUITE 152
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75203-1259
Practice Address - Country:US
Practice Address - Phone:214-948-2076
Practice Address - Fax:214-948-9990
Is Sole Proprietor?:No
Enumeration Date:2017-01-09
Last Update Date:2022-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAP132563363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner