Provider Demographics
NPI:1568126068
Name:LEWIS, DALE ANDREW (NP-C)
Entity type:Individual
Prefix:
First Name:DALE
Middle Name:ANDREW
Last Name:LEWIS
Suffix:
Gender:
Credentials:NP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 93295
Mailing Address - Street 2:
Mailing Address - City:CLEVELAND
Mailing Address - State:OH
Mailing Address - Zip Code:44193-5366
Mailing Address - Country:US
Mailing Address - Phone:615-550-2955
Mailing Address - Fax:615-550-2956
Practice Address - Street 1:4726 TRADERS WAY
Practice Address - Street 2:
Practice Address - City:THOMPSONS STATION
Practice Address - State:TN
Practice Address - Zip Code:37179-5366
Practice Address - Country:US
Practice Address - Phone:615-550-2955
Practice Address - Fax:615-550-2956
Is Sole Proprietor?:Yes
Enumeration Date:2021-10-30
Last Update Date:2025-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN30354363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily