Healthcare Provider Details

I. General information

NPI: 1740716984
Provider Name (Legal Business Name): HEATHER MICHELLE LEWIS FNP-C, DNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/09/2017
Last Update Date: 04/18/2025
Certification Date: 04/18/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

73360 HIGHWAY 111 STE 1
PALM DESERT CA
92260-3926
US

IV. Provider business mailing address

74924 VERBENA CT
INDIAN WELLS CA
92210-7233
US

V. Phone/Fax

Practice location:
  • Phone: 760-565-1193
  • Fax:
Mailing address:
  • Phone: 909-543-8910
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207QB0002X
TaxonomyObesity Medicine (Family Medicine) Physician
License Number95006578
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number95006578
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: