Provider Demographics
NPI:1457873770
Name:LEWIS, JESSICA MARIA (FNP-C)
Entity Type:Individual
Prefix:
First Name:JESSICA
Middle Name:MARIA
Last Name:LEWIS
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:49920 STATE ROUTE 379
Mailing Address - Street 2:
Mailing Address - City:LEWISVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:43754-9560
Mailing Address - Country:US
Mailing Address - Phone:330-324-3967
Mailing Address - Fax:
Practice Address - Street 1:225 RUSSELL AVE
Practice Address - Street 2:
Practice Address - City:NEW MARTINSVILLE
Practice Address - State:WV
Practice Address - Zip Code:26155-1572
Practice Address - Country:US
Practice Address - Phone:304-455-2600
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-07-07
Last Update Date:2018-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH020906207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine