Provider Demographics
NPI:1366470700
Name:LEWIS, PATRICIA D (CRNP)
Entity type:Individual
Prefix:
First Name:PATRICIA
Middle Name:D
Last Name:LEWIS
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:
Other - First Name:PATRICIA
Other - Middle Name:DIANNE
Other - Last Name:HOWELL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CRNP
Mailing Address - Street 1:657 HELEN KELLER BLVD
Mailing Address - Street 2:
Mailing Address - City:TUSCALOOSA
Mailing Address - State:AL
Mailing Address - Zip Code:35404-2983
Mailing Address - Country:US
Mailing Address - Phone:205-255-3784
Mailing Address - Fax:205-255-3775
Practice Address - Street 1:657 HELEN KELLER BLVD
Practice Address - Street 2:
Practice Address - City:TUSCALOOSA
Practice Address - State:AL
Practice Address - Zip Code:35404-2983
Practice Address - Country:US
Practice Address - Phone:205-255-3784
Practice Address - Fax:205-255-3775
Is Sole Proprietor?:No
Enumeration Date:2006-06-28
Last Update Date:2019-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSR892524363LX0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LX0001XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
LEW104291133OtherNCC BOARD
1-052298OtherALABAMA STATE MEDICAL LICENSE