Provider Demographics
NPI:1376796649
Name:LEWIS, JASMINE LAREE (RN, MSN, NP-C)
Entity Type:Individual
Prefix:
First Name:JASMINE
Middle Name:LAREE
Last Name:LEWIS
Suffix:
Gender:F
Credentials:RN, MSN, NP-C
Other - Prefix:
Other - First Name:JASMINE
Other - Middle Name:LAREE
Other - Last Name:NELSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN, MSN, NP-C
Mailing Address - Street 1:9715 BURNET RD
Mailing Address - Street 2:BLDG. 7, STE 200
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78758-5215
Mailing Address - Country:US
Mailing Address - Phone:512-505-5500
Mailing Address - Fax:512-334-2702
Practice Address - Street 1:12221 N MOPAC EXPY
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78758-2401
Practice Address - Country:US
Practice Address - Phone:512-505-5500
Practice Address - Fax:512-334-2702
Is Sole Proprietor?:No
Enumeration Date:2008-10-29
Last Update Date:2017-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAAP60057911363LF0000X
TXAP118170363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX563351YN57Medicare Oscar/Certification
TX563351YN56Medicare Oscar/Certification