Provider Demographics
NPI:1801533823
Name:LEWIS, ALEXIS COELHO (PA-C)
Entity type:Individual
Prefix:
First Name:ALEXIS
Middle Name:COELHO
Last Name:LEWIS
Suffix:
Gender:
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:130 PROVIDENCE RD STE 100
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28207-1247
Mailing Address - Country:US
Mailing Address - Phone:043-339-1137
Mailing Address - Fax:704-333-9757
Practice Address - Street 1:130 PROVIDENCE RD STE 100
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28207-1247
Practice Address - Country:US
Practice Address - Phone:704-333-9113
Practice Address - Fax:704-333-9757
Is Sole Proprietor?:No
Enumeration Date:2022-05-19
Last Update Date:2025-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPA9116176363A00000X
NC0010-14188363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant