Provider Demographics
NPI:1699494658
Name:LEWIS, NIKENYA D
Entity type:Individual
Prefix:
First Name:NIKENYA
Middle Name:D
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 1:8100 PINES RD APT 19D
Mailing Address - Street 2:
Mailing Address - City:SHREVEPORT
Mailing Address - State:LA
Mailing Address - Zip Code:71129-4454
Mailing Address - Country:US
Mailing Address - Phone:318-465-5971
Mailing Address - Fax:
Practice Address - Street 1:8100 PINES RD APT 19D
Practice Address - Street 2:
Practice Address - City:SHREVEPORT
Practice Address - State:LA
Practice Address - Zip Code:71129-4454
Practice Address - Country:US
Practice Address - Phone:318-465-5971
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-08-24
Last Update Date:2022-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XM0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistMental Health
No171M00000XOther Service ProvidersCase Manager/Care Coordinator