Most Relevant Information
Provider Data
| NPI Number: | 1003580945 |
| Provider Name: | LISA COUCH |
| Entity Type: | Individual |
| Taxonomy Code: | 363LF0000X |
| Specialty: | Nurse Practitioner |
| License Number: | 1049190 |
Most Important Dates
| Enumeration Date: | 08/04/2021 |
| Last Updated: | 02/09/2024 |
Provider Practice Location
1500 COOPER ST
FORT WORTH
TX
761042710
Practice Location Phone/Fax
| Phone: | 6828851116 |
| Fax: |
Provider Mailing Location
PO BOX 733784
DALLAS
TX
753733784
Provider Mailing Phone/Fax
| Phone: | 6828856483 |
| Fax: | 6828853113 |