Healthcare Provider Details

I. General information

NPI: 1831001668
Provider Name (Legal Business Name): CICELY LANEIGH ISABELL
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/17/2026
Last Update Date: 09/17/2026
Certification Date: 09/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2231 W GENTRY PKWY
TYLER TX
75702-2809
US

IV. Provider business mailing address

523 S FANNIN AVE
TYLER TX
75702-8204
US

V. Phone/Fax

Practice location:
  • Phone: 903-535-9041
  • Fax: 903-787-5098
Mailing address:
  • Phone: 903-535-9041
  • Fax: 903-531-9490

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number1249776
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: