Provider Demographics
NPI:1215285630
Name:LEWIS, JENNIFER K (FNP)
Entity type:Individual
Prefix:
First Name:JENNIFER
Middle Name:K
Last Name:LEWIS
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:36 LUCKY GAP
Mailing Address - Street 2:
Mailing Address - City:WEAVERVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28787-6608
Mailing Address - Country:US
Mailing Address - Phone:423-946-6178
Mailing Address - Fax:
Practice Address - Street 1:63 MONTICELLO RD
Practice Address - Street 2:
Practice Address - City:WEAVERVILLE
Practice Address - State:NC
Practice Address - Zip Code:28787-9441
Practice Address - Country:US
Practice Address - Phone:828-645-3066
Practice Address - Fax:828-252-8072
Is Sole Proprietor?:No
Enumeration Date:2012-08-15
Last Update Date:2023-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC250923363LF0000X, 363L00000X
NC5005776363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily