Healthcare Provider Details

I. General information

NPI: 1205762366
Provider Name (Legal Business Name): OLUBUKOLA ELIZABETH LEWIS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/18/2026
Last Update Date: 06/18/2026
Certification Date: 06/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4223 BRINKWORTH DR
FULSHEAR TX
77441-2803
US

IV. Provider business mailing address

4223 BRINKWORTH DR
FULSHEAR TX
77441-2803
US

V. Phone/Fax

Practice location:
  • Phone: 281-690-1183
  • Fax:
Mailing address:
  • Phone: 281-690-1183
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WP0807X
TaxonomyChild & Adolescent Psychiatric/Mental Health Registered Nurse
License Number1233097
License Number StateTX
# 2
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number965950
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: