MEDICARE: LINDSEY LACEY SEWELL FNP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LF0000X	Family Nurse Practitioner	AP141862	TX

General Provider Information

NPI Number	:	1780238865
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LINDSEY LACEY SEWELL FNP

Provider Business Mailing Address
First Line	:	5937 DONNELLY AVE
Second Line	:
City	:	FORT WORTH
State	:	TX
Zip	:	76107-5811
Country	:	US
Telephone Number	:	682-212-9140
Fax Number	:	682-212-0740

Provider Business Practice Location Address
First Line	:	5937 DONNELLY AVE
Second Line	:
City	:	FORT WORTH
State	:	TX
Zip	:	76107-5811
Country	:	US
Telephone Number	:	682-212-9140
Fax Number	:	682-212-0740

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/28/2019
Last Update Date	:	02/03/2023

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