Mary Lewis
Individual provider Active NPI Registered Nurse · Tyler, TX
NPI 1104494640 · NPPES record last updated Jun 11, 2021
Key facts
- NPI
- 1104494640
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Registered Nurse 163W00000X
- License
- 535011 (TX)
- Practice address
- 9846 Hwy 31 E
Tyler, TX 75705-2329 - Phone
- (903) 592-8001
- NPI assigned
- Jun 11, 2021
- Sex
- Female
- Sole proprietor
- No
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 535011 | TX | MD | Registered Nurse |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Registered Nurse | 163W00000X | 535011 | TX | Yes |
Addresses
Primary practice location
9846 Hwy 31 E
Tyler, TX 75705-2329
Mailing address
9846 Hwy 31 E
Tyler, TX 75705-2329
Other providers in Tyler, TX
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jun 11, 2021. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.