Provider Demographics
NPI:1346331121
Name:LEWIS, TELISCHA DENISE (ANP)
Entity Type:Individual
Prefix:
First Name:TELISCHA
Middle Name:DENISE
Last Name:LEWIS
Suffix:
Gender:F
Credentials:ANP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1661 AIRPORT RD
Mailing Address - Street 2:SUITE E
Mailing Address - City:HOT SPRINGS
Mailing Address - State:AR
Mailing Address - Zip Code:71913-7951
Mailing Address - Country:US
Mailing Address - Phone:501-881-4112
Mailing Address - Fax:501-767-6501
Practice Address - Street 1:1661 AIRPORT RD
Practice Address - Street 2:SUITE E
Practice Address - City:HOT SPRINGS
Practice Address - State:AR
Practice Address - Zip Code:71913-7951
Practice Address - Country:US
Practice Address - Phone:501-881-4112
Practice Address - Fax:501-767-6501
Is Sole Proprietor?:No
Enumeration Date:2006-09-27
Last Update Date:2011-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARA02946 ANP363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner