Provider Demographics
NPI:1306870811
Name:LEWIS, REBECCA G (FNP)
Entity type:Individual
Prefix:MS
First Name:REBECCA
Middle Name:G
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:PO BOX 1805
Mailing Address - Street 2:
Mailing Address - City:ALPINE
Mailing Address - State:TX
Mailing Address - Zip Code:79831-1805
Mailing Address - Country:US
Mailing Address - Phone:432-837-9887
Mailing Address - Fax:432-837-5476
Practice Address - Street 1:4114 MCKNIGHT RD STE C
Practice Address - Street 2:
Practice Address - City:TEXARKANA
Practice Address - State:TX
Practice Address - Zip Code:75503-1086
Practice Address - Country:US
Practice Address - Phone:501-492-0099
Practice Address - Fax:479-968-1673
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-10
Last Update Date:2025-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAP108276363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX172331403OtherMEDICAID THSTEPS
TX172331402Medicaid
TX172331403OtherMEDICAID THSTEPS
TX172331403OtherMEDICAID THSTEPS
TX172331402Medicaid