Provider Demographics
NPI:1952827222
Name:LEWIS, TYNEKIA
Entity Type:Individual
Prefix:
First Name:TYNEKIA
Middle Name:
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 1:5346 FLAT ROCK RD
Mailing Address - Street 2:
Mailing Address - City:ALBERTA
Mailing Address - State:VA
Mailing Address - Zip Code:23821-2206
Mailing Address - Country:US
Mailing Address - Phone:434-774-1959
Mailing Address - Fax:
Practice Address - Street 1:5346 FLAT ROCK RD
Practice Address - Street 2:
Practice Address - City:ALBERTA
Practice Address - State:VA
Practice Address - Zip Code:23821-2206
Practice Address - Country:US
Practice Address - Phone:434-774-1959
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-08-18
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172A00000XOther Service ProvidersDriver