Provider Demographics
NPI:1821668153
Name:LEWIS, JERRI (RN)
Entity Type:Individual
Prefix:
First Name:JERRI
Middle Name:
Last Name:LEWIS
Suffix:
Gender:F
Credentials:RN
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Other - First Name:
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Mailing Address - Street 1:3625 FERN VALLEY RD
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40219-1916
Mailing Address - Country:US
Mailing Address - Phone:502-964-3381
Mailing Address - Fax:502-759-5049
Practice Address - Street 1:3625 FERN VALLEY RD
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40219-1916
Practice Address - Country:US
Practice Address - Phone:502-964-3381
Practice Address - Fax:502-759-5049
Is Sole Proprietor?:No
Enumeration Date:2021-06-29
Last Update Date:2021-06-29
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
KY1122150364SL0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes364SL0600XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistLong-Term Care