Provider Demographics
NPI:1205235082
Name:ENGLEDOWL, LONE
Entity type:Individual
Prefix:
First Name:LONE
Middle Name:
Last Name:ENGLEDOWL
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1315 SANTA FE ST STE 201
Mailing Address - Street 2:
Mailing Address - City:CORPUS CHRISTI
Mailing Address - State:TX
Mailing Address - Zip Code:78404-2290
Mailing Address - Country:US
Mailing Address - Phone:361-887-9600
Mailing Address - Fax:361-883-1661
Practice Address - Street 1:1315 SANTA FE ST STE 201
Practice Address - Street 2:
Practice Address - City:CORPUS CHRISTI
Practice Address - State:TX
Practice Address - Zip Code:78404-2290
Practice Address - Country:US
Practice Address - Phone:361-929-6969
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-08-18
Last Update Date:2022-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAP126255363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX344515701Medicaid