Provider Demographics
NPI:1154727881
Name:LEWIS, SHEMIKO
Entity type:Individual
Prefix:
First Name:SHEMIKO
Middle Name:
Last Name:LEWIS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1827 HIGHWAY 162
Mailing Address - Street 2:
Mailing Address - City:BENTON
Mailing Address - State:LA
Mailing Address - Zip Code:71006-4526
Mailing Address - Country:US
Mailing Address - Phone:318-540-2889
Mailing Address - Fax:972-271-0190
Practice Address - Street 1:1827 HIGHWAY 162
Practice Address - Street 2:
Practice Address - City:BENTON
Practice Address - State:LA
Practice Address - Zip Code:71006-4526
Practice Address - Country:US
Practice Address - Phone:318-540-2889
Practice Address - Fax:972-271-0190
Is Sole Proprietor?:No
Enumeration Date:2014-11-06
Last Update Date:2014-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA006518538171W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171W00000XOther Service ProvidersContractor