Provider Demographics
NPI:1922362912
Name:LEWIS, KATIE CHEYENNE
Entity Type:Individual
Prefix:MISS
First Name:KATIE
Middle Name:CHEYENNE
Last Name:LEWIS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3571 HIGHWAY 63
Mailing Address - Street 2:
Mailing Address - City:BLACK ROCK
Mailing Address - State:AR
Mailing Address - Zip Code:72415-9022
Mailing Address - Country:US
Mailing Address - Phone:870-878-1156
Mailing Address - Fax:
Practice Address - Street 1:70 BATESVILLE BLVD
Practice Address - Street 2:
Practice Address - City:BATESVILLE
Practice Address - State:AR
Practice Address - Zip Code:72501-8970
Practice Address - Country:US
Practice Address - Phone:870-793-3199
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-06-25
Last Update Date:2016-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator