Provider Demographics
NPI:1649302688
Name:LEWIS, LINDA FRANCES (PSYD,RN,PMHCNSBC)
Entity type:Individual
Prefix:DR
First Name:LINDA
Middle Name:FRANCES
Last Name:LEWIS
Suffix:
Gender:F
Credentials:PSYD,RN,PMHCNSBC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Mailing Address - Street 1:528 WEST KERR
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:MO
Mailing Address - Zip Code:65803-2430
Mailing Address - Country:US
Mailing Address - Phone:417-866-1114
Mailing Address - Fax:417-866-8865
Practice Address - Street 1:1331 N STEWART AVE
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:MO
Practice Address - Zip Code:65802-2239
Practice Address - Country:US
Practice Address - Phone:417-866-1114
Practice Address - Fax:417-866-8865
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-12
Last Update Date:2010-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO055371363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO429695505Medicaid
MO429695505Medicaid