Provider Demographics
NPI:1528411576
Name:LEWIS, TALISHA R (NP)
Entity Type:Individual
Prefix:
First Name:TALISHA
Middle Name:R
Last Name:LEWIS
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:311 E PRINCETON DR
Mailing Address - Street 2:
Mailing Address - City:PRINCETON
Mailing Address - State:TX
Mailing Address - Zip Code:75407-9008
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:311 E PRINCETON DR
Practice Address - Street 2:
Practice Address - City:PRINCETON
Practice Address - State:TX
Practice Address - Zip Code:75407-9008
Practice Address - Country:US
Practice Address - Phone:866-389-2727
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-07-14
Last Update Date:2018-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAP131437363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily