Provider Demographics
NPI:1093825457
Name:LEWIS, JOHN VERNON (CS-FNP)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:VERNON
Last Name:LEWIS
Suffix:
Gender:M
Credentials:CS-FNP
Other - Prefix:
Other - First Name:JOHN
Other - Middle Name:VERNON
Other - Last Name:LEWIS
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:CS-FNP
Mailing Address - Street 1:8304 W 99TH ST
Mailing Address - Street 2:
Mailing Address - City:OVERLAND PARK
Mailing Address - State:KS
Mailing Address - Zip Code:66212-3470
Mailing Address - Country:US
Mailing Address - Phone:913-825-0159
Mailing Address - Fax:
Practice Address - Street 1:8304 W 99TH ST
Practice Address - Street 2:
Practice Address - City:OVERLAND PARK
Practice Address - State:KS
Practice Address - Zip Code:66212-3470
Practice Address - Country:US
Practice Address - Phone:913-825-0159
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO097714163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse