Provider Demographics
NPI:1316145345
Name:LEWIS, RADHIYA KIBIBI (FNP)
Entity type:Individual
Prefix:
First Name:RADHIYA
Middle Name:KIBIBI
Last Name:LEWIS
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:RADIYA
Other - Middle Name:KIBIBI
Other - Last Name:RASHADEEN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:FNP
Mailing Address - Street 1:8913 BLUEBONNET BLVD STE A
Mailing Address - Street 2:
Mailing Address - City:BATON ROUGE
Mailing Address - State:LA
Mailing Address - Zip Code:70810-2974
Mailing Address - Country:US
Mailing Address - Phone:225-612-3900
Mailing Address - Fax:225-612-3800
Practice Address - Street 1:8913 BLUEBONNET BLVD STE A
Practice Address - Street 2:
Practice Address - City:BATON ROUGE
Practice Address - State:LA
Practice Address - Zip Code:70810-2974
Practice Address - Country:US
Practice Address - Phone:225-612-3900
Practice Address - Fax:225-612-3800
Is Sole Proprietor?:Yes
Enumeration Date:2007-07-11
Last Update Date:2024-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAAP04943363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1350559Medicaid