Provider Demographics
NPI:1164796488
Name:LEWIS, LEANNA JAYE (NP-C)
Entity Type:Individual
Prefix:
First Name:LEANNA
Middle Name:JAYE
Last Name:LEWIS
Suffix:
Gender:F
Credentials:NP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:303 DARLING AVE
Mailing Address - Street 2:
Mailing Address - City:WAYCROSS
Mailing Address - State:GA
Mailing Address - Zip Code:31501-5223
Mailing Address - Country:US
Mailing Address - Phone:912-283-1717
Mailing Address - Fax:122-837-6339
Practice Address - Street 1:303 DARLING AVE
Practice Address - Street 2:
Practice Address - City:WAYCROSS
Practice Address - State:GA
Practice Address - Zip Code:31501-5223
Practice Address - Country:US
Practice Address - Phone:912-283-1717
Practice Address - Fax:912-283-7633
Is Sole Proprietor?:No
Enumeration Date:2012-03-05
Last Update Date:2020-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN161641363LF0000X, 363L00000X, 363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health