Provider Demographics
NPI:1033585427
Name:LEWIS, BRENT
Entity Type:Individual
Prefix:
First Name:BRENT
Middle Name:
Last Name:LEWIS
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:408 VIRGINIA ST
Mailing Address - Street 2:PO BOX 30
Mailing Address - City:PARIS
Mailing Address - State:TN
Mailing Address - Zip Code:38242-5341
Mailing Address - Country:US
Mailing Address - Phone:731-642-0521
Mailing Address - Fax:
Practice Address - Street 1:1263 US HIGHWAY 45 BYP N
Practice Address - Street 2:
Practice Address - City:TRENTON
Practice Address - State:TN
Practice Address - Zip Code:38382-4006
Practice Address - Country:US
Practice Address - Phone:731-642-0521
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-08-19
Last Update Date:2019-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNAPN0000020059363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health