Provider Demographics
NPI:1467854604
Name:LEWIS, JOHN NELSON (MD, MPH)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:NELSON
Last Name:LEWIS
Suffix:
Gender:M
Credentials:MD, MPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:225 SETTLERS POINT RD
Mailing Address - Street 2:
Mailing Address - City:FOUNTAIN RUN
Mailing Address - State:KY
Mailing Address - Zip Code:42133-8551
Mailing Address - Country:US
Mailing Address - Phone:502-569-7427
Mailing Address - Fax:
Practice Address - Street 1:225 SETTLERS POINT RD
Practice Address - Street 2:
Practice Address - City:FOUNTAIN RUN
Practice Address - State:KY
Practice Address - Zip Code:42133-8551
Practice Address - Country:US
Practice Address - Phone:502-569-7427
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-09-18
Last Update Date:2014-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY32223207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY32223OtherMEDICAL LICENSE NUMBER