Provider Demographics
NPI:1164802682
Name:LEWIS, JESSICA LEA (APRN)
Entity Type:Individual
Prefix:MS
First Name:JESSICA
Middle Name:LEA
Last Name:LEWIS
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:MS
Other - First Name:JESSICA
Other - Middle Name:LEA
Other - Last Name:LANG
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN
Mailing Address - Street 1:5200 COMMERCE CROSSINGS DR FL FLOOR
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40229-2182
Mailing Address - Country:US
Mailing Address - Phone:502-253-4924
Mailing Address - Fax:812-590-2614
Practice Address - Street 1:1919 STATE ST STE 446
Practice Address - Street 2:
Practice Address - City:NEW ALBANY
Practice Address - State:IN
Practice Address - Zip Code:47150-6809
Practice Address - Country:US
Practice Address - Phone:812-981-6511
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-06-01
Last Update Date:2023-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY3009406363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN300076800Medicaid
IN201337240Medicaid
KY211861OtherSIHO
KY000001009782OtherANTHEM
KY7100348040Medicaid
KY000001009782OtherANTHEM