Provider Demographics
NPI:1881785830
Name:LEWIS, TIMOTHY CLYDE (FNP)
Entity type:Individual
Prefix:
First Name:TIMOTHY
Middle Name:CLYDE
Last Name:LEWIS
Suffix:
Gender:M
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:67 QUAIL RIDGE DR
Mailing Address - Street 2:
Mailing Address - City:MONROE
Mailing Address - State:LA
Mailing Address - Zip Code:71203-9622
Mailing Address - Country:US
Mailing Address - Phone:318-372-8925
Mailing Address - Fax:318-396-3800
Practice Address - Street 1:206 BELL LN # C D
Practice Address - Street 2:
Practice Address - City:WEST MONROE
Practice Address - State:LA
Practice Address - Zip Code:71291-6300
Practice Address - Country:US
Practice Address - Phone:318-396-3800
Practice Address - Fax:318-396-3800
Is Sole Proprietor?:No
Enumeration Date:2006-09-27
Last Update Date:2007-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAAP05042363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily