Theresa Rae Lisenby, RN,CEO, INSTRUCTOR

Primary specialty

Medical-Surgical Registered NurseTaxonomy code 163WM0705X

License

572628 Issued in TX

Practice address

7471 FM 3094
Scurry, TX 75158-4915

Phone

(972) 452-3337

Fax

(972) 452-3331

NPI assigned

Jan 29, 2008

Last updated

Jan 29, 2008By the provider in NPPES

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 5

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Credentials

Registered Nurse

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Prospect Mountain Therapeutic Riding Center

  • Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
  • Scurry, TX
  • NPI 1306072780

  Student in an Organized Health Care Education/Training Program

  NPD (past) Authorized official

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1201564800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1201564800000",
    "number": "1073790358",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "7471 FM 3094",
            "city": "SCURRY",
            "state": "TX",
            "postal_code": "751584915",
            "telephone_number": "972-452-3337",
            "fax_number": "972-452-3331"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "7471 FM 3094",
            "city": "SCURRY",
            "state": "TX",
            "postal_code": "751584915",
            "telephone_number": "972-452-3337",
            "fax_number": "972-452-3331"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "LISENBY",
        "first_name": "THERESA",
        "middle_name": "RAE",
        "name_prefix": "Mrs.",
        "credential": "RN,CEO, INSTRUCTOR",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2008-01-29",
        "last_updated": "2008-01-29",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "163WM0705X",
            "taxonomy_group": "",
            "desc": "Registered Nurse, Medical-Surgical",
            "state": "TX",
            "license": "572628",
            "primary": true
        },
        {
            "code": "174400000X",
            "taxonomy_group": "",
            "desc": "Specialist",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "225500000X",
            "taxonomy_group": "",
            "desc": "Specialist/Technologist",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "225800000X",
            "taxonomy_group": "",
            "desc": "Recreation Therapist",
            "state": "NU",
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Donna Jewel Hernandez, LVN
• Heather Rachelle Jestis
• KB Support Services
• Kynan Kinley, M.A., LPC
• Randall Eugene Kitchen, LPC, LCDC
• Prospect Mountain Therapeutic Riding Center
• Scurry-Rosser Independent School District
• Sandra Lynn Starnes
• Baleigh Sims Stibbens, LCSW
• Lawrene Villarreal

• Medical-Surgical Registered Nurse in Scurry, TX
• Providers in Scurry, TX by specialty
• Medical-Surgical Registered Nurse in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 29, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.