1376796649 NPI number — JASMINE LAREE LEWIS RN, MSN, NP-C

Table of content: JASMINE LAREE LEWIS RN, MSN, NP-C (NPI 1376796649)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1376796649 NPI number — JASMINE LAREE LEWIS RN, MSN, NP-C

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
LEWIS
Provider First Name:
JASMINE
Provider Middle Name:
LAREE
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
RN, MSN, NP-C
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
NELSON
Provider Other First Name:
JASMINE
Provider Other Middle Name:
LAREE
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
RN, MSN, NP-C
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1376796649
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
04/24/2017
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
9715 BURNET RD
Provider Second Line Business Mailing Address:
BLDG. 7, STE 200
Provider Business Mailing Address City Name:
AUSTIN
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
78758-5215
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
512-505-5500
Provider Business Mailing Address Fax Number:
512-334-2702

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
12221 N MOPAC EXPY
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
AUSTIN
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
78758-2401
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
512-505-5500
Provider Business Practice Location Address Fax Number:
512-334-2702
Provider Enumeration Date:
10/29/2008

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 363LF0000X , with the licence number:  AP60057911 , registered in the state of WA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 363LF0000X , with the licence number: AP118170 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)