Provider Demographics
NPI:1710072343
Name:HUIE, THERESA LYNN (RNC, FNP)
Entity Type:Individual
Prefix:MS
First Name:THERESA
Middle Name:LYNN
Last Name:HUIE
Suffix:
Gender:F
Credentials:RNC, FNP
Other - Prefix:
Other - First Name:THERESA
Other - Middle Name:LYNN
Other - Last Name:ALEXANDER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:100 W CORPORATE DR
Mailing Address - Street 2:
Mailing Address - City:LEWISVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:75067-6510
Mailing Address - Country:US
Mailing Address - Phone:972-459-7757
Mailing Address - Fax:972-459-4673
Practice Address - Street 1:100 W CORPORATE DR
Practice Address - Street 2:
Practice Address - City:LEWISVILLE
Practice Address - State:TX
Practice Address - Zip Code:75067-6510
Practice Address - Country:US
Practice Address - Phone:972-459-7757
Practice Address - Fax:972-459-4673
Is Sole Proprietor?:No
Enumeration Date:2006-10-03
Last Update Date:2009-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX608267363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX163424801Medicaid
TX8K5889Medicare UPIN