Provider Demographics
NPI:1710741434
Name:LEWIS, KAYLI
Entity Type:Individual
Prefix:
First Name:KAYLI
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 1:726 RIVERVIEW DR
Mailing Address - Street 2:
Mailing Address - City:BELMONT
Mailing Address - State:WV
Mailing Address - Zip Code:26134-9719
Mailing Address - Country:US
Mailing Address - Phone:304-665-1450
Mailing Address - Fax:304-665-1452
Practice Address - Street 1:726 RIVERVIEW DR
Practice Address - Street 2:
Practice Address - City:BELMONT
Practice Address - State:WV
Practice Address - Zip Code:26134-9719
Practice Address - Country:US
Practice Address - Phone:304-665-1450
Practice Address - Fax:304-665-1452
Is Sole Proprietor?:No
Enumeration Date:2024-02-13
Last Update Date:2024-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant