Provider Demographics
NPI:1144534652
Name:LEWIS, JESSICA SHEARL (CRNA)
Entity type:Individual
Prefix:MRS
First Name:JESSICA
Middle Name:SHEARL
Last Name:LEWIS
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:MS
Other - First Name:JESSICA
Other - Middle Name:MICHELLE
Other - Last Name:SHEARL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CRNA
Mailing Address - Street 1:3735 GLENLAKE DR STE 250
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28208-6866
Mailing Address - Country:US
Mailing Address - Phone:704-749-5800
Mailing Address - Fax:954-851-1746
Practice Address - Street 1:3735 GLENLAKE DR STE 250
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28208-6866
Practice Address - Country:US
Practice Address - Phone:704-749-5800
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-07-27
Last Update Date:2023-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC202152367500000X
VA0024171628367500000X
NC2755367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered