Provider Demographics
NPI:1265164123
Name:LEWIS, CARMEN SYDNI (PA)
Entity type:Individual
Prefix:
First Name:CARMEN
Middle Name:SYDNI
Last Name:LEWIS
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:221 STERLING FARM DR
Mailing Address - Street 2:
Mailing Address - City:JACKSON
Mailing Address - State:TN
Mailing Address - Zip Code:38305-5727
Mailing Address - Country:US
Mailing Address - Phone:731-300-6163
Mailing Address - Fax:731-300-6955
Practice Address - Street 1:221 STERLING FARM DR
Practice Address - Street 2:
Practice Address - City:JACKSON
Practice Address - State:TN
Practice Address - Zip Code:38305-5727
Practice Address - Country:US
Practice Address - Phone:731-300-6163
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-06-29
Last Update Date:2024-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN6146363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant