Provider Demographics
NPI:1447757653
Name:JOHNSON-FULSOM, LEWIS LA'PAUL
Entity Type:Individual
Prefix:
First Name:LEWIS
Middle Name:LA'PAUL
Last Name:JOHNSON-FULSOM
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1023
Mailing Address - Street 2:
Mailing Address - City:MEXIA
Mailing Address - State:TX
Mailing Address - Zip Code:76667-1023
Mailing Address - Country:US
Mailing Address - Phone:254-366-9403
Mailing Address - Fax:
Practice Address - Street 1:310 N WEST ST
Practice Address - Street 2:
Practice Address - City:MEXIA
Practice Address - State:TX
Practice Address - Zip Code:76667-3043
Practice Address - Country:US
Practice Address - Phone:254-366-9403
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-04-12
Last Update Date:2018-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant