Provider Demographics
NPI:1497409981
Name:WILLIAMS-LEWIS, SHAWUANNA (NURSE PRACTITIONER)
Entity Type:Individual
Prefix:
First Name:SHAWUANNA
Middle Name:
Last Name:WILLIAMS-LEWIS
Suffix:
Gender:F
Credentials:NURSE PRACTITIONER
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:660 N STATE ST STE 200
Mailing Address - Street 2:
Mailing Address - City:JACKSON
Mailing Address - State:MS
Mailing Address - Zip Code:39202-3303
Mailing Address - Country:US
Mailing Address - Phone:601-503-0121
Mailing Address - Fax:
Practice Address - Street 1:4607 LINDBERGH DR
Practice Address - Street 2:
Practice Address - City:JACKSON
Practice Address - State:MS
Practice Address - Zip Code:39209-3855
Practice Address - Country:US
Practice Address - Phone:601-353-6142
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-02-04
Last Update Date:2022-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS905150363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Single Specialty