Provider Demographics
NPI:1548052525
Name:LEWIS, LEETHA WYNNE (REGISTERED NURSE)
Entity type:Individual
Prefix:
First Name:LEETHA
Middle Name:WYNNE
Last Name:LEWIS
Suffix:
Gender:F
Credentials:REGISTERED NURSE
Other - Prefix:
Other - First Name:LEETHA
Other - Middle Name:
Other - Last Name:LEWIS
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:REGISTERED NURSE
Mailing Address - Street 1:149 FIELDVIEW DR
Mailing Address - Street 2:
Mailing Address - City:VERSAILLES
Mailing Address - State:KY
Mailing Address - Zip Code:40383-0836
Mailing Address - Country:US
Mailing Address - Phone:859-492-7211
Mailing Address - Fax:
Practice Address - Street 1:3775 BELLEAU WOOD DR
Practice Address - Street 2:
Practice Address - City:LEXINGTON
Practice Address - State:KY
Practice Address - Zip Code:40517-1804
Practice Address - Country:US
Practice Address - Phone:859-271-9001
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-05-19
Last Update Date:2025-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY1070535163WG0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WG0000XNursing Service ProvidersRegistered NurseGeneral Practice