Provider Demographics
NPI:1609236934
Name:LEWIS, KIMBERLY
Entity Type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:
Last Name:LEWIS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:330 W NYE LN
Mailing Address - Street 2:28
Mailing Address - City:CARSON CITY
Mailing Address - State:NV
Mailing Address - Zip Code:89706-3803
Mailing Address - Country:US
Mailing Address - Phone:775-291-1665
Mailing Address - Fax:
Practice Address - Street 1:330 W NYE LN
Practice Address - Street 2:28
Practice Address - City:CARSON CITY
Practice Address - State:NV
Practice Address - Zip Code:89706-3803
Practice Address - Country:US
Practice Address - Phone:775-291-1665
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-02-29
Last Update Date:2016-02-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV374U00000X
NVCNA026579376K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide
No376K00000XNursing Service Related ProvidersNurse's Aide