Provider Demographics
NPI:1285232371
Name:LEWIS, KASONDRA GLYNN (PMHNP-BC)
Entity type:Individual
Prefix:MRS
First Name:KASONDRA
Middle Name:GLYNN
Last Name:LEWIS
Suffix:
Gender:F
Credentials:PMHNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1374 HIGHWAY 192 E STE 400
Mailing Address - Street 2:
Mailing Address - City:LONDON
Mailing Address - State:KY
Mailing Address - Zip Code:40741-3123
Mailing Address - Country:US
Mailing Address - Phone:606-770-5454
Mailing Address - Fax:
Practice Address - Street 1:1374 HIGHWAY 192 E STE 400
Practice Address - Street 2:
Practice Address - City:LONDON
Practice Address - State:KY
Practice Address - Zip Code:40741-3123
Practice Address - Country:US
Practice Address - Phone:606-770-5454
Practice Address - Fax:606-770-5455
Is Sole Proprietor?:No
Enumeration Date:2020-10-12
Last Update Date:2024-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY4027957363LP0808X
KY1158287163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No163W00000XNursing Service ProvidersRegistered Nurse