Provider Demographics
NPI:1255910113
Name:LEWIS, KELLI WINGETT (APRN-CNM)
Entity type:Individual
Prefix:
First Name:KELLI
Middle Name:WINGETT
Last Name:LEWIS
Suffix:
Gender:F
Credentials:APRN-CNM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2008 S ORMOND AVE
Mailing Address - Street 2:
Mailing Address - City:GONZALES
Mailing Address - State:LA
Mailing Address - Zip Code:70737-4958
Mailing Address - Country:US
Mailing Address - Phone:225-910-1144
Mailing Address - Fax:
Practice Address - Street 1:277 RUE DE LA VIE ST
Practice Address - Street 2:
Practice Address - City:BATON ROUGE
Practice Address - State:LA
Practice Address - Zip Code:70817-5133
Practice Address - Country:US
Practice Address - Phone:225-761-1200
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-04-06
Last Update Date:2021-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA218053176B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes176B00000XOther Service ProvidersMidwife