Provider Demographics
NPI:1952068314
Name:HOOF, LYEISHA
Entity Type:Individual
Prefix:
First Name:LYEISHA
Middle Name:
Last Name:HOOF
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 1:1443 N BLUEGROVE RD
Mailing Address - Street 2:
Mailing Address - City:LANCASTER
Mailing Address - State:TX
Mailing Address - Zip Code:75134-2937
Mailing Address - Country:US
Mailing Address - Phone:817-896-5108
Mailing Address - Fax:
Practice Address - Street 1:4400 TX-121
Practice Address - Street 2:SUITE 614
Practice Address - City:LEWISVILLE
Practice Address - State:TX
Practice Address - Zip Code:75056
Practice Address - Country:US
Practice Address - Phone:972-204-5092
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-11-19
Last Update Date:2021-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL1-168069163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse