Provider Demographics
NPI:1326523895
Name:LEWIS, KYMBERLY E'LON
Entity Type:Individual
Prefix:
First Name:KYMBERLY
Middle Name:E'LON
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 1:926 OLMSTEAD RD
Mailing Address - Street 2:
Mailing Address - City:PIKESVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:21208-4756
Mailing Address - Country:US
Mailing Address - Phone:443-800-4324
Mailing Address - Fax:
Practice Address - Street 1:5550 NEWBURY STREET
Practice Address - Street 2:SUITE A OFFICE E
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21208-3673
Practice Address - Country:US
Practice Address - Phone:443-804-3240
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-10-01
Last Update Date:2018-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
374J00000X
MDR00898225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist
No374J00000XNursing Service Related ProvidersDoula