Provider Demographics
NPI:1548920713
Name:LEWIS, KATRINA (APRN)
Entity type:Individual
Prefix:
First Name:KATRINA
Middle Name:
Last Name:LEWIS
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7556 US HIGHWAY 70
Mailing Address - Street 2:
Mailing Address - City:BARTLETT
Mailing Address - State:TN
Mailing Address - Zip Code:38133-2686
Mailing Address - Country:US
Mailing Address - Phone:901-552-3497
Mailing Address - Fax:574-635-9228
Practice Address - Street 1:7556 US HIGHWAY 70
Practice Address - Street 2:
Practice Address - City:BARTLETT
Practice Address - State:TN
Practice Address - Zip Code:38133-2686
Practice Address - Country:US
Practice Address - Phone:901-552-3497
Practice Address - Fax:574-635-9228
Is Sole Proprietor?:Yes
Enumeration Date:2021-12-29
Last Update Date:2024-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH0037168363LP0808X
MTAPRN-241826363LP0808X
TX1127717363LP0808X
TN30885363LP0808X
FLTPAN2487363LP0808X
MO2024030905363LP0808X
COC-RXN.0100755-C-NP363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Single Specialty