Provider Demographics
NPI:1225093123
Name:LEWIS, KATHERINE JANIS (APRN)
Entity Type:Individual
Prefix:MS
First Name:KATHERINE
Middle Name:JANIS
Last Name:LEWIS
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4206 FRAZIER PIKE
Mailing Address - Street 2:
Mailing Address - City:LITTLE ROCK
Mailing Address - State:AR
Mailing Address - Zip Code:72206-9635
Mailing Address - Country:US
Mailing Address - Phone:501-490-2440
Mailing Address - Fax:501-490-0156
Practice Address - Street 1:4206 FRAZIER PIKE
Practice Address - Street 2:
Practice Address - City:LITTLE ROCK
Practice Address - State:AR
Practice Address - Zip Code:72206-9635
Practice Address - Country:US
Practice Address - Phone:501-490-2440
Practice Address - Fax:501-490-0156
Is Sole Proprietor?:No
Enumeration Date:2006-04-20
Last Update Date:2012-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARR50938207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine