Provider Demographics
NPI:1497464226
Name:LEWIS, KATELYNN ANN (INDIVIDUAL)
Entity Type:Individual
Prefix:
First Name:KATELYNN
Middle Name:ANN
Last Name:LEWIS
Suffix:
Gender:F
Credentials:INDIVIDUAL
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5339 OLENTANGY DR
Mailing Address - Street 2:
Mailing Address - City:DAYTON
Mailing Address - State:OH
Mailing Address - Zip Code:45431-1435
Mailing Address - Country:US
Mailing Address - Phone:937-250-2801
Mailing Address - Fax:
Practice Address - Street 1:5339 OLENTANGY DR
Practice Address - Street 2:
Practice Address - City:DAYTON
Practice Address - State:OH
Practice Address - Zip Code:45431-1435
Practice Address - Country:US
Practice Address - Phone:937-250-2801
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-11-21
Last Update Date:2022-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHUN858955374U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide