Healthcare Provider Details

I. General information

NPI: 1184498867
Provider Name (Legal Business Name): LEXI VELASQUEZ FNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/13/2023
Last Update Date: 11/13/2023
Certification Date: 11/13/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

387 W IH 10
FORT STOCKTON TX
79735-2708
US

IV. Provider business mailing address

387 W IH 10
FORT STOCKTON TX
79735-2708
US

V. Phone/Fax

Practice location:
  • Phone: 432-336-2004
  • Fax:
Mailing address:
  • Phone: 432-336-2004
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number1139064
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: