Provider Demographics
NPI:1972567956
Name:LEWIS, MICHELLE D (FNP, ACNP)
Entity type:Individual
Prefix:MS
First Name:MICHELLE
Middle Name:D
Last Name:LEWIS
Suffix:
Gender:F
Credentials:FNP, ACNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4408 EATON CIR
Mailing Address - Street 2:
Mailing Address - City:COLLEYVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:76034-4652
Mailing Address - Country:US
Mailing Address - Phone:817-368-1565
Mailing Address - Fax:
Practice Address - Street 1:9900 BREN RD EAST
Practice Address - Street 2:MAIL ROUTE MN 008-B213
Practice Address - City:MINNETONKA
Practice Address - State:MN
Practice Address - Zip Code:55343-9664
Practice Address - Country:US
Practice Address - Phone:817-368-1565
Practice Address - Fax:817-416-0145
Is Sole Proprietor?:No
Enumeration Date:2006-04-14
Last Update Date:2020-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX606929363LA2100X
TXAP112278363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX160864802Medicaid
TXTXB113986Medicare PIN
TX160864802Medicaid