Provider Demographics
NPI:1508621343
Name:LEWIS, DEBORAH NICKS
Entity Type:Individual
Prefix:
First Name:DEBORAH
Middle Name:NICKS
Last Name:LEWIS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1919 PORTSMOUTH ST APT 21
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77098-4236
Mailing Address - Country:US
Mailing Address - Phone:842-614-9375
Mailing Address - Fax:
Practice Address - Street 1:1900 W GRAY ST # 130252
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77019-4816
Practice Address - Country:US
Practice Address - Phone:832-614-9375
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-02-20
Last Update Date:2024-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1744P3200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1744P3200XOther Service ProvidersSpecialistProsthetics Case Management
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX251B00000XMedicaid