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General NPI Number Information
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NPI Number | 1205445418
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Entity Type | Individual
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Provider Name | LATINA LEWIS
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Gender | Female
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Dates
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Enumeration Date | 07/24/2020
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Last Update Date | 07/24/2020
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Provider Practice Location Address
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Address Line | 3501 S SONCY RD STE 110
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City | AMARILLO
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State | TX
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Zip | 79119-6405
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Country | US
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Telephone | 806-353-1400
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Fax | 806-353-1404
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Provider Business Mailing Address
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Address Line | PO BOX 8337
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City | AMARILLO
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State | TX
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Zip | 79114-8337
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Country | US
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Telephone | 806-355-6593
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Fax | 806-352-8774
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number | 1005240
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License Number State | TX
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