Provider Demographics
NPI:1417403056
Name:LEWIS, KRISTEN (APN)
Entity Type:Individual
Prefix:MRS
First Name:KRISTEN
Middle Name:
Last Name:LEWIS
Suffix:
Gender:F
Credentials:APN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1580 LAKEWOOD RD STE 16
Mailing Address - Street 2:
Mailing Address - City:TOMS RIVER
Mailing Address - State:NJ
Mailing Address - Zip Code:08755-3287
Mailing Address - Country:US
Mailing Address - Phone:732-456-7777
Mailing Address - Fax:848-251-2189
Practice Address - Street 1:111 W WATER ST
Practice Address - Street 2:
Practice Address - City:TOMS RIVER
Practice Address - State:NJ
Practice Address - Zip Code:08753
Practice Address - Country:US
Practice Address - Phone:732-244-4700
Practice Address - Fax:732-244-2804
Is Sole Proprietor?:No
Enumeration Date:2016-09-01
Last Update Date:2018-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ26NJ00618700363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily