Healthcare Provider Details

I. General information

NPI: 1144974551
Provider Name (Legal Business Name): HEATHER KATHLEEN LEWIS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/05/2022
Last Update Date: 02/05/2022
Certification Date: 02/05/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13917 W HIGHWAY 71 STE A
AUSTIN TX
78738-3008
US

IV. Provider business mailing address

13917 W HIGHWAY 71 STE A
AUSTIN TX
78738-3008
US

V. Phone/Fax

Practice location:
  • Phone: 512-610-7030
  • Fax:
Mailing address:
  • Phone: 512-610-7030
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number1069903
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: