Provider Demographics
NPI:1790342947
Name:LEWIS, JAYCI R (PA-C)
Entity Type:Individual
Prefix:
First Name:JAYCI
Middle Name:R
Last Name:LEWIS
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:JAYCI
Other - Middle Name:RAE
Other - Last Name:FLEMING
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:6517 NW 149TH ST
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73142-7870
Mailing Address - Country:US
Mailing Address - Phone:405-249-3018
Mailing Address - Fax:
Practice Address - Street 1:1407 N WHISENANT DR
Practice Address - Street 2:
Practice Address - City:DUNCAN
Practice Address - State:OK
Practice Address - Zip Code:73533-1650
Practice Address - Country:US
Practice Address - Phone:580-251-8440
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-05-23
Last Update Date:2021-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant