Healthcare Provider Details

I. General information

NPI: 1023034667
Provider Name (Legal Business Name): TOWNE CENTRE FAMILY HEALTHCARE CLINIC, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/15/2006
Last Update Date: 03/13/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

156 S MAIN ST STE 120
LUMBERTON TX
77657-7882
US

IV. Provider business mailing address

156 S MAIN ST SUITE 120
LUMBERTON TX
77657-7881
US

V. Phone/Fax

Practice location:
  • Phone: 409-658-4315
  • Fax:
Mailing address:
  • Phone: 409-755-2842
  • Fax: 409-755-2855

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number595640
License Number StateTX

VIII. Authorized Official

Name: KATHLEEN LEWIS
Title or Position: MRS.LEWIS
Credential: C-FNP
Phone: 409-755-2842