Provider Demographics
NPI:1699532614
Name:LEWIS, JAVONDA JOSZELL (NEMT)
Entity type:Individual
Prefix:
First Name:JAVONDA
Middle Name:JOSZELL
Last Name:LEWIS
Suffix:
Gender:F
Credentials:NEMT
Other - Prefix:
Other - First Name:JAVONDA
Other - Middle Name:JOSZELL
Other - Last Name:LEWIS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:NEMT
Mailing Address - Street 1:24011 RICHARDS RD APT 2111
Mailing Address - Street 2:
Mailing Address - City:SPRING
Mailing Address - State:TX
Mailing Address - Zip Code:77386-3283
Mailing Address - Country:US
Mailing Address - Phone:504-900-6134
Mailing Address - Fax:
Practice Address - Street 1:24011 RICHARDS RD APT 2111
Practice Address - Street 2:
Practice Address - City:SPRING
Practice Address - State:TX
Practice Address - Zip Code:77386-3283
Practice Address - Country:US
Practice Address - Phone:504-900-6134
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-03-05
Last Update Date:2024-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX49338786347C00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes347C00000XTransportation ServicesPrivate Vehicle