Healthcare Provider Details

I. General information

NPI: 1639511793
Provider Name (Legal Business Name): SHELETA NECOLE LEWIS FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/17/2013
Last Update Date: 08/20/2025
Certification Date: 08/20/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

820 E FRONT ST
TYLER TX
75702-8326
US

IV. Provider business mailing address

3355 FM 346 N
BULLARD TX
75757-6448
US

V. Phone/Fax

Practice location:
  • Phone: 903-596-0602
  • Fax: 903-596-0620
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAP125065
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: