Provider Demographics
NPI:1164729984
Name:LEWIS, BETTY MALISA (FNP)
Entity type:Individual
Prefix:MRS
First Name:BETTY
Middle Name:MALISA
Last Name:LEWIS
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1610 5TH ST
Mailing Address - Street 2:
Mailing Address - City:LUBBOCK
Mailing Address - State:TX
Mailing Address - Zip Code:79401-2622
Mailing Address - Country:US
Mailing Address - Phone:806-765-2611
Mailing Address - Fax:
Practice Address - Street 1:5424 19TH ST STE 200
Practice Address - Street 2:
Practice Address - City:LUBBOCK
Practice Address - State:TX
Practice Address - Zip Code:79407-2163
Practice Address - Country:US
Practice Address - Phone:806-722-4453
Practice Address - Fax:806-722-4461
Is Sole Proprietor?:No
Enumeration Date:2011-02-14
Last Update Date:2024-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX721431363LF0000X
TXAP12002363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily