Provider Demographics
NPI:1851915367
Name:LEWIS, KAYEETA VERNETTA (F05200254, AP146169)
Entity type:Individual
Prefix:MRS
First Name:KAYEETA
Middle Name:VERNETTA
Last Name:LEWIS
Suffix:
Gender:F
Credentials:F05200254, AP146169
Other - Prefix:
Other - First Name:KAYEETA
Other - Middle Name:VERNETTA
Other - Last Name:SAULS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:FNP, APRN
Mailing Address - Street 1:5144 E SAM HOUSTON PKWY N STE 121
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77015-3225
Mailing Address - Country:US
Mailing Address - Phone:713-253-5319
Mailing Address - Fax:888-509-1499
Practice Address - Street 1:5144 E SAM HOUSTON PKWY N STE 121
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77015-3225
Practice Address - Country:US
Practice Address - Phone:713-253-5319
Practice Address - Fax:888-509-1499
Is Sole Proprietor?:Yes
Enumeration Date:2020-06-01
Last Update Date:2024-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX146169163WG0000X
TXF05200254363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163WG0000XNursing Service ProvidersRegistered NurseGeneral Practice