Provider Demographics
NPI:1811627565
Name:LEWIS, AUDREANNA (CNM)
Entity Type:Individual
Prefix:
First Name:AUDREANNA
Middle Name:
Last Name:LEWIS
Suffix:
Gender:F
Credentials:CNM
Other - Prefix:MISS
Other - First Name:AUDREANNA
Other - Middle Name:
Other - Last Name:LEWIS
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:CNM
Mailing Address - Street 1:143 JOHN WILLIS RD
Mailing Address - Street 2:
Mailing Address - City:WIGGINS
Mailing Address - State:MS
Mailing Address - Zip Code:39577-9346
Mailing Address - Country:US
Mailing Address - Phone:662-836-8564
Mailing Address - Fax:
Practice Address - Street 1:405 BRIARWOOD DR
Practice Address - Street 2:
Practice Address - City:JACKSON
Practice Address - State:MS
Practice Address - Zip Code:39206-3052
Practice Address - Country:US
Practice Address - Phone:769-233-8163
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-06-15
Last Update Date:2022-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS899578176B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes176B00000XOther Service ProvidersMidwife