Provider Demographics
NPI:1578021523
Name:WINEGAR, LOURIE LEA (MSN, RN, PMHNP-BC)
Entity Type:Individual
Prefix:
First Name:LOURIE
Middle Name:LEA
Last Name:WINEGAR
Suffix:
Gender:F
Credentials:MSN, RN, PMHNP-BC
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 3046
Mailing Address - Street 2:
Mailing Address - City:MALVERN
Mailing Address - State:PA
Mailing Address - Zip Code:19355-0746
Mailing Address - Country:US
Mailing Address - Phone:806-354-1810
Mailing Address - Fax:806-354-1852
Practice Address - Street 1:7201 EVANS ST
Practice Address - Street 2:
Practice Address - City:AMARILLO
Practice Address - State:TX
Practice Address - Zip Code:79106-1707
Practice Address - Country:US
Practice Address - Phone:806-354-1810
Practice Address - Fax:806-354-1852
Is Sole Proprietor?:Yes
Enumeration Date:2019-03-08
Last Update Date:2020-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX585129363LP0808X
TXAP139237363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM46928545Medicaid
OK200921070AMedicaid
TX1F7178OtherPTAN