Provider Demographics
NPI:1558110940
Name:LEWIS, KEVIN DWAYNE
Entity type:Individual
Prefix:
First Name:KEVIN
Middle Name:DWAYNE
Last Name:LEWIS
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13714 KELLERTON LN
Mailing Address - Street 2:
Mailing Address - City:CYPRESS
Mailing Address - State:TX
Mailing Address - Zip Code:77429-2390
Mailing Address - Country:US
Mailing Address - Phone:281-825-1562
Mailing Address - Fax:
Practice Address - Street 1:13714 KELLERTON LN
Practice Address - Street 2:
Practice Address - City:CYPRESS
Practice Address - State:TX
Practice Address - Zip Code:77429-2390
Practice Address - Country:US
Practice Address - Phone:281-825-1562
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-05-16
Last Update Date:2024-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care