Provider Demographics
NPI:1164793246
Name:LEWIS, AMY RENEE (RN, AGPCNP-BC)
Entity type:Individual
Prefix:MRS
First Name:AMY
Middle Name:RENEE
Last Name:LEWIS
Suffix:
Gender:F
Credentials:RN, AGPCNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2800 E BROAD ST STE 517
Mailing Address - Street 2:
Mailing Address - City:MANSFIELD
Mailing Address - State:TX
Mailing Address - Zip Code:76063-6417
Mailing Address - Country:US
Mailing Address - Phone:817-592-3360
Mailing Address - Fax:817-549-5151
Practice Address - Street 1:2800 E BROAD ST STE 517
Practice Address - Street 2:
Practice Address - City:MANSFIELD
Practice Address - State:TX
Practice Address - Zip Code:76063-6417
Practice Address - Country:US
Practice Address - Phone:817-592-3360
Practice Address - Fax:817-549-5151
Is Sole Proprietor?:No
Enumeration Date:2012-01-20
Last Update Date:2025-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAP121311363LA2200X, 363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXV0190197OtherTEXAS DEPARTMENT OF PUBLIC SAFETY (DPS) CONTROLLED SUBSTANCES REG.
TX6R7554OtherGROUP MEDICARE PTAN
TXBCBSOther8XC231
TXTXB157975Medicare PIN