Provider Demographics
NPI:1902187875
Name:LEWIS, TAMIKA S (NP)
Entity Type:Individual
Prefix:
First Name:TAMIKA
Middle Name:S
Last Name:LEWIS
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:28610 HWY 290 STE F09 #164
Mailing Address - Street 2:P.O. 164
Mailing Address - City:CYPRESS
Mailing Address - State:TX
Mailing Address - Zip Code:77433-5463
Mailing Address - Country:US
Mailing Address - Phone:281-215-5220
Mailing Address - Fax:
Practice Address - Street 1:13302 GRANT RD STE 5
Practice Address - Street 2:
Practice Address - City:CYPRESS
Practice Address - State:TX
Practice Address - Zip Code:77429-3518
Practice Address - Country:US
Practice Address - Phone:713-960-8008
Practice Address - Fax:713-960-0965
Is Sole Proprietor?:No
Enumeration Date:2011-09-06
Last Update Date:2019-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI4513363L00000X
TX1990363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
NAOtherN/A
NAOtherNA