Provider Demographics
NPI:1730335829
Name:HENNIGAN, ALLISON LANIER (MD)
Entity type:Individual
Prefix:DR
First Name:ALLISON
Middle Name:LANIER
Last Name:HENNIGAN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:MISS
Other - First Name:ALLISON
Other - Middle Name:LANGFORD
Other - Last Name:LANIER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1301 DOCTORS DR
Mailing Address - Street 2:
Mailing Address - City:TYLER
Mailing Address - State:TX
Mailing Address - Zip Code:75701-2239
Mailing Address - Country:US
Mailing Address - Phone:903-405-2880
Mailing Address - Fax:
Practice Address - Street 1:1301 DOCTORS DR
Practice Address - Street 2:
Practice Address - City:TYLER
Practice Address - State:TX
Practice Address - Zip Code:75701
Practice Address - Country:US
Practice Address - Phone:903-405-2880
Practice Address - Fax:903-405-1881
Is Sole Proprietor?:No
Enumeration Date:2008-08-08
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXN63512084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX830515069OtherTAX ID