Provider Demographics
NPI:1780133959
Name:LEWIS, CHELSEA K (FNP-C)
Entity type:Individual
Prefix:
First Name:CHELSEA
Middle Name:K
Last Name:LEWIS
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2811 LEROY CIR APT D
Mailing Address - Street 2:
Mailing Address - City:KILLEEN
Mailing Address - State:TX
Mailing Address - Zip Code:76542-3233
Mailing Address - Country:US
Mailing Address - Phone:415-509-0610
Mailing Address - Fax:
Practice Address - Street 1:1141 PEAR TREE LN
Practice Address - Street 2:
Practice Address - City:NAPA
Practice Address - State:CA
Practice Address - Zip Code:94558-6484
Practice Address - Country:US
Practice Address - Phone:512-228-9456
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-09-28
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAP132070363LF0000X
CA95008696363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXAP132070OtherLICENSE