Provider Demographics
NPI:1164793246
Name:LEWIS, AMY RENEE (RN, AGPCNP-BC)
Entity type:Individual
Prefix:MRS
First Name:AMY
Middle Name:RENEE
Last Name:LEWIS
Suffix:
Gender:F
Credentials:RN, AGPCNP-BC
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Mailing Address - Street 1:2800 E BROAD ST STE 517
Mailing Address - Street 2:
Mailing Address - City:MANSFIELD
Mailing Address - State:TX
Mailing Address - Zip Code:76063-6417
Mailing Address - Country:US
Mailing Address - Phone:817-592-3002
Mailing Address - Fax:817-549-5151
Practice Address - Street 1:2800 E BROAD ST STE 517
Practice Address - Street 2:
Practice Address - City:MANSFIELD
Practice Address - State:TX
Practice Address - Zip Code:76063-6417
Practice Address - Country:US
Practice Address - Phone:817-592-3002
Practice Address - Fax:817-549-5151
Is Sole Proprietor?:No
Enumeration Date:2012-01-20
Last Update Date:2024-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX676199363LA2200X
TXAP121311363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXTXB157975OtherMEDICARE PTAN
TXV0190197OtherTEXAS DEPARTMENT OF PUBLIC SAFETY (DPS) CONTROLLED SUBSTANCES REG.
TXV0190197OtherTEXAS DEPARTMENT OF PUBLIC SAFETY (DPS) CONTROLLED SUBSTANCES REG.
TXTXB157975Medicare PIN