Provider Demographics
NPI:1255315883
Name:LEWIS, SHAUNDA L (APRN, BC)
Entity Type:Individual
Prefix:MRS
First Name:SHAUNDA
Middle Name:L
Last Name:LEWIS
Suffix:
Gender:F
Credentials:APRN, BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:644 HIGHWAY 114 S
Mailing Address - Street 2:P. O. BOX 99
Mailing Address - City:SCOTTS HILL
Mailing Address - State:TN
Mailing Address - Zip Code:38374-5023
Mailing Address - Country:US
Mailing Address - Phone:731-549-3191
Mailing Address - Fax:731-549-3005
Practice Address - Street 1:644 HIGHWAY 114 S
Practice Address - Street 2:
Practice Address - City:SCOTTS HILL
Practice Address - State:TN
Practice Address - Zip Code:38374-5023
Practice Address - Country:US
Practice Address - Phone:731-549-3191
Practice Address - Fax:731-549-3005
Is Sole Proprietor?:Yes
Enumeration Date:2005-12-06
Last Update Date:2011-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNAPN0000005099363LP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3341695Medicaid
TN4035615OtherBLUE CROSS BLUE SHIELD OF
TN3341695Medicaid
TN3341695Medicare PIN