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NPI Code Detail

MEDICARE: OLIVIA LEWIS

MEDICARE: OLIVIA LEWIS
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1363LP2300XPrimary Care Nurse Practitioner882419TX

General Provider Information

NPI Number : 1689522609
Entity Type Code : Individual
Provider Name (Legal Business Name) : OLIVIA LEWIS
Provider Business Mailing Address
First Line : 5904 SUMMERFIELD DR
Second Line :
City : TEXARKANA
State : TX
Zip : 75503-4306
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 5904 SUMMERFIELD DR
Second Line :
City : TEXARKANA
State : TX
Zip : 75503-4306
Country : US
Telephone Number : 430-200-4350
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/17/2026
Last Update Date : 03/17/2026

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Directions to “ OLIVIA LEWIS ” Practice Location

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