Individual provider Active NPI

Lisa Gail Wilkins, AGNP

  • Nurse Practitioner
  • Dallas, TX
National Provider Identifier
1437695863
Registry record updated Mar 9, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Nurse PractitionerTaxonomy code 363L00000X
License
AP132563 Issued in TX
Practice address
1411 N Beckley Ave
Pavilion III, Suite 152
Dallas, TX 75203-1259
Phone
(214) 948-2076
Fax
(214) 948-9990
NPI assigned
Jan 9, 2017
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Mar 9, 2022

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Nurse Practitioner 363L00000X AP132563 TX Primary

Addresses

Primary practice location

1411 N Beckley Ave
Pavilion III, Suite 152
Dallas, TX 75203-1259

Mailing address

1411 N. Beckley Ave.
Pavilion III Suite 152
Dallas, TX 75203
Phone (214) 948-2076

Other names 1

  • Lisa Gail Montgomery Former name

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in TX
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20170222002491 TX Practitioner - Nurse Practitioner 7113201922 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2016
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
University of Texas Southwestern Medical Center at DallasGroup PAC ID 0648188250, 3,156 clinicians

Practice addresses (Care Compare)

5303 Harry Hines Blvd
Dallas, TX 75390-7208
Phone (214) 645-0624

Hospital & facility affiliations

  • Ut of Texas Southwestern University Hospital - William P. Clements Jr. Hospital, Dallas, TX, CCN 450044

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Nurse Practitioner

State licenses

LicenseStateTypeSpecialty
AP132563TXMDNurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
University of Texas Southwestern Medical Center at Dallas CurrentSince Feb 1, 2023 Accepting new patients
Medhealth CurrentSince Feb 1, 2017 Accepting new patients
The University of Texas Southwestern Medical Center at Dallas CurrentSince Feb 1, 2023 Accepting new patients
University of Texas Southwestern Medical Center at Dallas Current Accepting new patients
Medhealth CurrentSince Feb 1, 2017 Accepting new patients
University of Texas Southwestern Medical Center at Dallas Past Accepting new patients
Advanced Pain & Rehabilitation Association PLLC Past Accepting new patients

Locations

5201 Harry Hines Blvd
Dallas, TX 75235
Phone (214) 590-1396

1411 N Beckley Ave
Ste 152
Dallas, TX 75203
Phone 2149487700208

1441 N Beckley Ave
Dallas, TX 75203
Phone (214) 712-2429

3000 N Interstate 35
Denton, TX 76201
Phone (469) 303-3591

5224 S State Highway 360
Grand Prairie, TX 75052
Phone (972) 522-0691

2821 E President George Bush Hwy
Ste 410
Richardson, TX 75082
Phone (469) 204-4800

5303 Harry Hines Blvd
Ut Southwest Medical Center, TX 75390
Phone (214) 645-2300

613 S Highway 78
Wylie, TX 75098
Phone (972) 941-8700

Organizations & group practices 7

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

Hospital & facility affiliations 1

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

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

{
    "created_epoch": "1483920000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1646784000000",
    "number": "1437695863",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1411 N. BECKLEY AVE.",
            "address_2": "PAVILION III SUITE 152",
            "city": "DALLAS",
            "state": "TX",
            "postal_code": "75203",
            "telephone_number": "214-948-2076",
            "fax_number": "214-948-9990"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1411 N BECKLEY AVE",
            "address_2": "PAVILION III, SUITE 152",
            "city": "DALLAS",
            "state": "TX",
            "postal_code": "752031259",
            "telephone_number": "214-948-2076",
            "fax_number": "214-948-9990"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WILKINS",
        "first_name": "LISA",
        "middle_name": "GAIL",
        "name_prefix": "Ms.",
        "credential": "AGNP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2017-01-09",
        "last_updated": "2022-03-09",
        "certification_date": "2022-03-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363L00000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner",
            "state": "TX",
            "license": "AP132563",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "LISA",
            "last_name": "MONTGOMERY",
            "middle_name": "GAIL",
            "credential": "AGNP",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

Other providers in Dallas, TX

Sources for this page

Verify at the official NPI Registry.