Provider Demographics
NPI:1255758652
Name:LEWIS, FELICIA (LVN)
Entity type:Individual
Prefix:
First Name:FELICIA
Middle Name:
Last Name:LEWIS
Suffix:
Gender:F
Credentials:LVN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:811 DERBY LN
Mailing Address - Street 2:
Mailing Address - City:MISSOURI CITY
Mailing Address - State:TX
Mailing Address - Zip Code:77489-3259
Mailing Address - Country:US
Mailing Address - Phone:281-650-6562
Mailing Address - Fax:
Practice Address - Street 1:811 DERBY LN
Practice Address - Street 2:STE 200
Practice Address - City:MISSOURI CITY
Practice Address - State:TX
Practice Address - Zip Code:77489-3259
Practice Address - Country:US
Practice Address - Phone:281-650-6562
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-03-24
Last Update Date:2017-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX178323372600000X, 171W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171W00000XOther Service ProvidersContractor
No372600000XNursing Service Related ProvidersAdult Companion