Basic Information
| Provider Information | |||||||||
| NPI: | 1780963496 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | LEWIS | ||||||||
| FirstName: | NIKKI | ||||||||
| MiddleName: | N | ||||||||
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| Credential: | NP | ||||||||
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| Mailing Information | |||||||||
| Address1: | 5460 BABCOCK RD | ||||||||
| Address2: | STE 120C | ||||||||
| City: | SAN ANTONIO | ||||||||
| State: | TX | ||||||||
| PostalCode: | 782403901 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7138500049 | ||||||||
| FaxNumber: | 7136277302 | ||||||||
| Practice Location | |||||||||
| Address1: | 4314 YOAKUM BLVD | ||||||||
| Address2: | |||||||||
| City: | HOUSTON | ||||||||
| State: | TX | ||||||||
| PostalCode: | 770065818 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7138500049 | ||||||||
| FaxNumber: | 7136277302 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/11/2011 | ||||||||
| LastUpdateDate: | 01/11/2017 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363LG0600X | 712063 | TX | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Gerontology |
No ID Information.