Provider Demographics
NPI:1821070053
Name:LEWIS, LUCREASIE (ARNP)
Entity Type:Individual
Prefix:
First Name:LUCREASIE
Middle Name:
Last Name:LEWIS
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:441 GORMAN HOLLOW RD
Mailing Address - Street 2:
Mailing Address - City:HAZARD
Mailing Address - State:KY
Mailing Address - Zip Code:41701-2315
Mailing Address - Country:US
Mailing Address - Phone:606-439-2361
Mailing Address - Fax:606-439-0870
Practice Address - Street 1:441 GORMAN HOLLOW RD
Practice Address - Street 2:
Practice Address - City:HAZARD
Practice Address - State:KY
Practice Address - Zip Code:41701-2315
Practice Address - Country:US
Practice Address - Phone:606-439-2361
Practice Address - Fax:606-439-0870
Is Sole Proprietor?:No
Enumeration Date:2005-11-15
Last Update Date:2020-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY1058965163WC1500X
KY2973P363LW0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's Health
No163WC1500XNursing Service ProvidersRegistered NurseCommunity Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY000000112279OtherANTHEM BC BS
KY20036018Medicaid
KY0281904Medicare PIN
KY0281704Medicare PIN
KY0631501Medicare PIN
KY000000112279OtherANTHEM BC BS
P00482Medicare UPIN
KY20036018Medicaid
KY0281505Medicare PIN
KY0281805Medicare PIN
KY0059624Medicare PIN