Provider Demographics
NPI:1518323427
Name:LEWIS, VIRGINIA DENISE (PMHNP)
Entity Type:Individual
Prefix:MRS
First Name:VIRGINIA
Middle Name:DENISE
Last Name:LEWIS
Suffix:
Gender:F
Credentials:PMHNP
Other - Prefix:
Other - First Name:VIRGINIA
Other - Middle Name:DENISE
Other - Last Name:PERRY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN
Mailing Address - Street 1:PO BOX 157A
Mailing Address - Street 2:3550 HIGHWAY 468 WEST
Mailing Address - City:WHITFIELD
Mailing Address - State:MS
Mailing Address - Zip Code:39193-0157
Mailing Address - Country:US
Mailing Address - Phone:601-351-8000
Mailing Address - Fax:601-351-8586
Practice Address - Street 1:3450 HIGHWAY 80 W
Practice Address - Street 2:
Practice Address - City:JACKSON
Practice Address - State:MS
Practice Address - Zip Code:39209-7201
Practice Address - Country:US
Practice Address - Phone:601-321-2400
Practice Address - Fax:601-985-5174
Is Sole Proprietor?:No
Enumeration Date:2016-01-07
Last Update Date:2019-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS901385363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health