1508377888 NPI number — KETRINA E LEWIS NURSE PRACTITIONER

Table of content: KETRINA E LEWIS NURSE PRACTITIONER (NPI 1508377888)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1508377888 NPI number — KETRINA E LEWIS NURSE PRACTITIONER

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
LEWIS
Provider First Name:
KETRINA
Provider Middle Name:
E
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
NURSE PRACTITIONER
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1508377888
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
11/08/2019
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
809 N CENTRAL EXPY
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MCKINNEY
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
75070-3303
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
972-529-4500
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
4700 LAS VEGAS BLVD N
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
NELLIS AFB
Provider Business Practice Location Address State Name:
NV
Provider Business Practice Location Address Postal Code:
89191-6600
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
702-653-2965
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
10/13/2017

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 363LP2300X , with the licence number:  CNP-03123 , registered in the state of NM ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 363L00000X , with the licence number: AP143211 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)