Provider Demographics
NPI:1497247811
Name:LEWIA, STEPHEN DOUGLAS JR (PA-C)
Entity Type:Individual
Prefix:DR
First Name:STEPHEN
Middle Name:DOUGLAS
Last Name:LEWIA
Suffix:JR
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:150 N MCLEAN BLVD APT 238
Mailing Address - Street 2:
Mailing Address - City:WICHITA
Mailing Address - State:KS
Mailing Address - Zip Code:67203-5940
Mailing Address - Country:US
Mailing Address - Phone:703-378-2382
Mailing Address - Fax:
Practice Address - Street 1:510 E CARTHAGE ST
Practice Address - Street 2:
Practice Address - City:MEADE
Practice Address - State:KS
Practice Address - Zip Code:67864-6401
Practice Address - Country:US
Practice Address - Phone:620-873-2112
Practice Address - Fax:620-873-5371
Is Sole Proprietor?:No
Enumeration Date:2018-06-01
Last Update Date:2021-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPA55973363A00000X
VA0110-007212363A00000X
KS15-02343363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant