Provider Demographics
NPI:1417789397
Name:LEWIS, KAYLEE RENEE
Entity type:Individual
Prefix:
First Name:KAYLEE
Middle Name:RENEE
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 1:400 KANAWHA VIEW RD
Mailing Address - Street 2:
Mailing Address - City:RED HOUSE
Mailing Address - State:WV
Mailing Address - Zip Code:25168-7553
Mailing Address - Country:US
Mailing Address - Phone:304-365-3099
Mailing Address - Fax:
Practice Address - Street 1:400 KANAWHA VIEW RD
Practice Address - Street 2:
Practice Address - City:RED HOUSE
Practice Address - State:WV
Practice Address - Zip Code:25168-7553
Practice Address - Country:US
Practice Address - Phone:304-365-3099
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-08-19
Last Update Date:2024-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant