Provider Demographics
NPI:1215415260
Name:LEWIS, TAMMY J
Entity Type:Individual
Prefix:
First Name:TAMMY
Middle Name:J
Last Name:LEWIS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 214
Mailing Address - Street 2:
Mailing Address - City:ANNVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40402-0214
Mailing Address - Country:US
Mailing Address - Phone:606-824-4005
Mailing Address - Fax:
Practice Address - Street 1:103 CAMPUS DR
Practice Address - Street 2:
Practice Address - City:ANNVILLE
Practice Address - State:KY
Practice Address - Zip Code:40402-8271
Practice Address - Country:US
Practice Address - Phone:606-824-4005
Practice Address - Fax:859-813-5394
Is Sole Proprietor?:Yes
Enumeration Date:2018-08-01
Last Update Date:2018-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY175T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175T00000XOther Service ProvidersPeer Specialist