Provider Demographics
NPI:1154820777
Name:LEWIS, NATHAN DONALD
Entity Type:Individual
Prefix:
First Name:NATHAN
Middle Name:DONALD
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 1:125 N. MAIN CROSS ST.
Mailing Address - Street 2:
Mailing Address - City:LOUISA
Mailing Address - State:KY
Mailing Address - Zip Code:41230
Mailing Address - Country:US
Mailing Address - Phone:606-876-2167
Mailing Address - Fax:
Practice Address - Street 1:758 STOCKTON RD
Practice Address - Street 2:
Practice Address - City:WALLINGFORD
Practice Address - State:KY
Practice Address - Zip Code:41093-8650
Practice Address - Country:US
Practice Address - Phone:606-876-2167
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-02-09
Last Update Date:2018-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY175T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175T00000XOther Service ProvidersPeer Specialist