Healthcare Provider Details

I. General information

NPI: 1407805526
Provider Name (Legal Business Name): LOLA FAYE HOUSTON N.P.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: LOLA FAYE HEWLETT N.P.

II. Dates (important events)

Enumeration Date: 05/08/2006
Last Update Date: 11/03/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

319 8TH ST SUITE 1
HENDERSON KY
42420-2963
US

IV. Provider business mailing address

1305 N ELM ST
HENDERSON KY
42420-2783
US

V. Phone/Fax

Practice location:
  • Phone: 270-827-5657
  • Fax: 270-827-8833
Mailing address:
  • Phone: 270-631-2412
  • Fax: 270-827-7530

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LG0600X
TaxonomyGerontology Nurse Practitioner
License Number3002129
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: