Provider Demographics
NPI:1306194576
Name:LEWIS, KAREN LYNN (NP)
Entity Type:Individual
Prefix:MRS
First Name:KAREN
Middle Name:LYNN
Last Name:LEWIS
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:636 2ND AVE
Mailing Address - Street 2:
Mailing Address - City:ROCHELLE
Mailing Address - State:GA
Mailing Address - Zip Code:31079-2046
Mailing Address - Country:US
Mailing Address - Phone:229-365-2570
Mailing Address - Fax:229-365-2571
Practice Address - Street 1:636 2ND AVE
Practice Address - Street 2:
Practice Address - City:ROCHELLE
Practice Address - State:GA
Practice Address - Zip Code:31079-2046
Practice Address - Country:US
Practice Address - Phone:229-365-2570
Practice Address - Fax:229-365-2571
Is Sole Proprietor?:No
Enumeration Date:2012-08-20
Last Update Date:2013-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN180944363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA003127311BMedicaid