Provider Demographics
NPI:1568357218
Name:LEWIS, ERIN KAYLA (FNP-C)
Entity type:Individual
Prefix:
First Name:ERIN
Middle Name:KAYLA
Last Name:LEWIS
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:MISS
Other - First Name:ERIN
Other - Middle Name:KAYLA
Other - Last Name:DALTON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:907 N ILLINOIS ROUTE 3
Mailing Address - Street 2:
Mailing Address - City:WATERLOO
Mailing Address - State:IL
Mailing Address - Zip Code:62298-1074
Mailing Address - Country:US
Mailing Address - Phone:618-350-0200
Mailing Address - Fax:
Practice Address - Street 1:907 N ILLINOIS ROUTE 3
Practice Address - Street 2:
Practice Address - City:WATERLOO
Practice Address - State:IL
Practice Address - Zip Code:62298-1074
Practice Address - Country:US
Practice Address - Phone:618-350-0200
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-06-12
Last Update Date:2025-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ILF06250119363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner