Provider Demographics
NPI:1942782214
Name:LEWIS, SHERICKA (QBHP)
Entity Type:Individual
Prefix:MS
First Name:SHERICKA
Middle Name:
Last Name:LEWIS
Suffix:
Gender:F
Credentials:QBHP
Other - Prefix:MRS
Other - First Name:SHERICKA
Other - Middle Name:LEWIS
Other - Last Name:MONTGOMERY
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:703 CALVIN AVERY DR
Mailing Address - Street 2:
Mailing Address - City:WEST MEMPHIS
Mailing Address - State:AR
Mailing Address - Zip Code:72301-6501
Mailing Address - Country:US
Mailing Address - Phone:870-732-1878
Mailing Address - Fax:
Practice Address - Street 1:304 N 6TH ST
Practice Address - Street 2:
Practice Address - City:WEST MEMPHIS
Practice Address - State:AR
Practice Address - Zip Code:72301-3221
Practice Address - Country:US
Practice Address - Phone:870-702-7657
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-09-04
Last Update Date:2018-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator