Provider Demographics
NPI:1477578615
Name:LEWIS, TERESA LYNN (FNP)
Entity Type:Individual
Prefix:
First Name:TERESA
Middle Name:LYNN
Last Name:LEWIS
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:TERESA
Other - Middle Name:LYNN
Other - Last Name:GEE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:223 S BROOKFIELD DR
Mailing Address - Street 2:
Mailing Address - City:LAFAYETTE
Mailing Address - State:IN
Mailing Address - Zip Code:47905-7223
Mailing Address - Country:US
Mailing Address - Phone:765-426-6339
Mailing Address - Fax:
Practice Address - Street 1:2400 SAGAMORE PKWY S
Practice Address - Street 2:
Practice Address - City:LAFAYETTE
Practice Address - State:IN
Practice Address - Zip Code:47905-5116
Practice Address - Country:US
Practice Address - Phone:765-772-4086
Practice Address - Fax:765-772-4086
Is Sole Proprietor?:No
Enumeration Date:2006-07-12
Last Update Date:2022-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN71001192A363L00000X, 207P00000X, 363L00000X
IAA143129363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200880950Medicaid
IN809640NNMedicare PIN
IN200880950Medicaid
INP00475183Medicare PIN