Provider Demographics
NPI:1730585035
Name:LEWIS, SAMANTHA SHARRON (APRN)
Entity type:Individual
Prefix:
First Name:SAMANTHA
Middle Name:SHARRON
Last Name:LEWIS
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:182 ROY CAMPBELL DR
Mailing Address - Street 2:
Mailing Address - City:HAZARD
Mailing Address - State:KY
Mailing Address - Zip Code:41701-9407
Mailing Address - Country:US
Mailing Address - Phone:606-435-0888
Mailing Address - Fax:606-435-0886
Practice Address - Street 1:182 ROY CAMPBELL DR
Practice Address - Street 2:
Practice Address - City:HAZARD
Practice Address - State:KY
Practice Address - Zip Code:41701-9407
Practice Address - Country:US
Practice Address - Phone:606-435-0888
Practice Address - Fax:606-435-0886
Is Sole Proprietor?:No
Enumeration Date:2014-11-13
Last Update Date:2023-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY3009079363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY7100332490Medicaid