Provider Demographics
NPI:1841900651
Name:LEWIS, BRANDON JEFFERY (APRN)
Entity type:Individual
Prefix:
First Name:BRANDON
Middle Name:JEFFERY
Last Name:LEWIS
Suffix:
Gender:M
Credentials:APRN
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 29190
Mailing Address - Street 2:
Mailing Address - City:BELFAST
Mailing Address - State:ME
Mailing Address - Zip Code:04915-2043
Mailing Address - Country:US
Mailing Address - Phone:844-994-6633
Mailing Address - Fax:470-300-7913
Practice Address - Street 1:1671 BELLE ISLE AVE STE 110J
Practice Address - Street 2:
Practice Address - City:MOUNT PLEASANT
Practice Address - State:SC
Practice Address - Zip Code:29464-8336
Practice Address - Country:US
Practice Address - Phone:844-994-6633
Practice Address - Fax:470-300-7913
Is Sole Proprietor?:No
Enumeration Date:2022-12-02
Last Update Date:2025-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC28328363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner