1972567956 NPI number — MS. MICHELLE D LEWIS FNP, ACNP

Table of content: MS. MICHELLE D LEWIS FNP, ACNP (NPI 1972567956)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1972567956 NPI number — MS. MICHELLE D LEWIS FNP, ACNP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
LEWIS
Provider First Name:
MICHELLE
Provider Middle Name:
D
Provider Name Prefix Text:
MS.
Provider Name Suffix Text:
Provider Credential Text:
FNP, ACNP
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1972567956
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
09/17/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
4408 EATON CIR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
COLLEYVILLE
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
76034-4652
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
817-368-1565
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
9900 BREN RD EAST
Provider Second Line Business Practice Location Address:
MAIL ROUTE MN 008-B213
Provider Business Practice Location Address City Name:
MINNETONKA
Provider Business Practice Location Address State Name:
MN
Provider Business Practice Location Address Postal Code:
55343-9664
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
817-368-1565
Provider Business Practice Location Address Fax Number:
817-416-0145
Provider Enumeration Date:
04/14/2006

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: 363LA2100X , with the licence number:  606929 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 363LF0000X , with the licence number: AP112278 , 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)

  • Identifier: 160864802 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".




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