Provider Demographics
NPI:1245264779
Name:LEWIS, ANITA KAREN (MS,RD,LD)
Entity type:Individual
Prefix:MS
First Name:ANITA
Middle Name:KAREN
Last Name:LEWIS
Suffix:
Gender:F
Credentials:MS,RD,LD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11229 HELEN DR
Mailing Address - Street 2:
Mailing Address - City:GULFPORT
Mailing Address - State:MS
Mailing Address - Zip Code:39503-3975
Mailing Address - Country:US
Mailing Address - Phone:228-523-5838
Mailing Address - Fax:228-523-4508
Practice Address - Street 1:400 VETERANS AVE
Practice Address - Street 2:NUTRITION AND FOOD SERVICE (120)
Practice Address - City:BILOXI
Practice Address - State:MS
Practice Address - Zip Code:39531-2410
Practice Address - Country:US
Practice Address - Phone:228-523-5838
Practice Address - Fax:228-523-4508
Is Sole Proprietor?:No
Enumeration Date:2006-07-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS479556133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered