Provider Demographics
NPI:1407166168
Name:LEWIS, SHACHRISTA LE'SHAUN (CNA,CHHA)
Entity Type:Individual
Prefix:MRS
First Name:SHACHRISTA
Middle Name:LE'SHAUN
Last Name:LEWIS
Suffix:
Gender:F
Credentials:CNA,CHHA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3212 PARKER DR
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73135-1436
Mailing Address - Country:US
Mailing Address - Phone:405-326-1332
Mailing Address - Fax:
Practice Address - Street 1:3212 PARKER DR
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73135-1436
Practice Address - Country:US
Practice Address - Phone:405-326-1332
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-10-15
Last Update Date:2010-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK3707936108020172V00000X
OK37V479361005172V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker