Provider Demographics
NPI:1205453958
Name:NYANTIKA, LEWIS NCHOGA (CERTIFIED FNP)
Entity type:Individual
Prefix:
First Name:LEWIS
Middle Name:NCHOGA
Last Name:NYANTIKA
Suffix:
Gender:M
Credentials:CERTIFIED FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:715 N FIELDER RD STE C
Mailing Address - Street 2:
Mailing Address - City:ARLINGTON
Mailing Address - State:TX
Mailing Address - Zip Code:76012-4695
Mailing Address - Country:US
Mailing Address - Phone:817-962-0056
Mailing Address - Fax:817-962-0057
Practice Address - Street 1:715 N FIELDER RD STE C
Practice Address - Street 2:
Practice Address - City:ARLINGTON
Practice Address - State:TX
Practice Address - Zip Code:76012-4695
Practice Address - Country:US
Practice Address - Phone:817-962-0056
Practice Address - Fax:817-962-0057
Is Sole Proprietor?:No
Enumeration Date:2020-06-29
Last Update Date:2020-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX827337363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily