Provider Demographics
NPI:1730132499
Name:LEWIS, KATHERINE SPRATLEY (CNM)
Entity Type:Individual
Prefix:MRS
First Name:KATHERINE
Middle Name:SPRATLEY
Last Name:LEWIS
Suffix:
Gender:F
Credentials:CNM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:657 SKYLINE DR
Mailing Address - Street 2:
Mailing Address - City:JACKSON
Mailing Address - State:TN
Mailing Address - Zip Code:38301-3903
Mailing Address - Country:US
Mailing Address - Phone:731-541-8425
Mailing Address - Fax:731-541-8420
Practice Address - Street 1:657 SKYLINE DR
Practice Address - Street 2:
Practice Address - City:JACKSON
Practice Address - State:TN
Practice Address - Zip Code:38305
Practice Address - Country:US
Practice Address - Phone:731-541-8425
Practice Address - Fax:731-541-8420
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-17
Last Update Date:2011-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNAPN0000012730367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAP56298Medicare UPIN