Provider Demographics
NPI:1558814962
Name:LEWIS, MEGAN L (APRN)
Entity Type:Individual
Prefix:
First Name:MEGAN
Middle Name:L
Last Name:LEWIS
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:MEGAN
Other - Middle Name:L
Other - Last Name:BREWER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:APRN
Mailing Address - Street 1:210 BLACK GOLD BLVD STE 210
Mailing Address - Street 2:
Mailing Address - City:HAZARD
Mailing Address - State:KY
Mailing Address - Zip Code:41701-2620
Mailing Address - Country:US
Mailing Address - Phone:606-487-7000
Mailing Address - Fax:606-487-7022
Practice Address - Street 1:210 BLACK GOLD BLVD STE 210
Practice Address - Street 2:
Practice Address - City:HAZARD
Practice Address - State:KY
Practice Address - Zip Code:41701-2620
Practice Address - Country:US
Practice Address - Phone:606-487-7000
Practice Address - Fax:606-487-7022
Is Sole Proprietor?:No
Enumeration Date:2016-08-02
Last Update Date:2020-11-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY3010536363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY7100438190Medicaid