Provider Demographics
NPI:1922043793
Name:LEWIS, STACY (CNM)
Entity Type:Individual
Prefix:
First Name:STACY
Middle Name:
Last Name:LEWIS
Suffix:
Gender:F
Credentials:CNM
Other - Prefix:
Other - First Name:STACY
Other - Middle Name:
Other - Last Name:GREEN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1141 N LOOP 1604 E # 105187
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78232-1339
Mailing Address - Country:US
Mailing Address - Phone:806-316-2158
Mailing Address - Fax:866-399-0991
Practice Address - Street 1:2265 BRIDLEWOOD RANCHES DR
Practice Address - Street 2:
Practice Address - City:SAN MARCOS
Practice Address - State:TX
Practice Address - Zip Code:78666-1991
Practice Address - Country:US
Practice Address - Phone:210-296-8661
Practice Address - Fax:866-399-0991
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-17
Last Update Date:2020-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice MidwifeGroup - Single Specialty