Provider Demographics
NPI:1316409592
Name:LEWIS, JUSTIN LAVELLE (CRNP)
Entity Type:Individual
Prefix:
First Name:JUSTIN
Middle Name:LAVELLE
Last Name:LEWIS
Suffix:
Gender:M
Credentials:CRNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5005 OSCAR BAXTER DR
Mailing Address - Street 2:
Mailing Address - City:TUSCALOOSA
Mailing Address - State:AL
Mailing Address - Zip Code:35405-3698
Mailing Address - Country:US
Mailing Address - Phone:205-343-2225
Mailing Address - Fax:205-343-7825
Practice Address - Street 1:5005 OSCAR BAXTER DR
Practice Address - Street 2:
Practice Address - City:TUSCALOOSA
Practice Address - State:AL
Practice Address - Zip Code:35405-3698
Practice Address - Country:US
Practice Address - Phone:205-343-2225
Practice Address - Fax:205-343-7825
Is Sole Proprietor?:No
Enumeration Date:2019-04-04
Last Update Date:2020-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL1-135286363LF0000X, 207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily