Provider Demographics
NPI:1407805526
Name:HOUSTON, LOLA FAYE (NP)
Entity Type:Individual
Prefix:
First Name:LOLA
Middle Name:FAYE
Last Name:HOUSTON
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:LOLA
Other - Middle Name:FAYE
Other - Last Name:HEWLETT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:NP
Mailing Address - Street 1:1305 N ELM ST
Mailing Address - Street 2:
Mailing Address - City:HENDERSON
Mailing Address - State:KY
Mailing Address - Zip Code:42420-2783
Mailing Address - Country:US
Mailing Address - Phone:270-631-2412
Mailing Address - Fax:270-827-7530
Practice Address - Street 1:319 8TH ST
Practice Address - Street 2:SUITE 1
Practice Address - City:HENDERSON
Practice Address - State:KY
Practice Address - Zip Code:42420-2963
Practice Address - Country:US
Practice Address - Phone:270-827-5657
Practice Address - Fax:270-827-8833
Is Sole Proprietor?:No
Enumeration Date:2006-05-08
Last Update Date:2016-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY3002129363LG0600X
KY2129P363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Yes363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY78001450Medicaid
0665318Medicare PIN
KY78001450Medicaid
00648001Medicare PIN
0694301Medicare PIN
P48161Medicare UPIN