Provider Demographics
NPI:1891317764
Name:LEWIS, KAYLEE (CRNP)
Entity type:Individual
Prefix:
First Name:KAYLEE
Middle Name:
Last Name:LEWIS
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:158 SAWGRASS DR
Mailing Address - Street 2:
Mailing Address - City:BRIGHTON
Mailing Address - State:NY
Mailing Address - Zip Code:14620-4648
Mailing Address - Country:US
Mailing Address - Phone:585-274-0363
Mailing Address - Fax:
Practice Address - Street 1:158 SAWGRASS DR
Practice Address - Street 2:
Practice Address - City:BRIGHTON
Practice Address - State:NY
Practice Address - Zip Code:14620-4648
Practice Address - Country:US
Practice Address - Phone:585-274-0363
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-05-13
Last Update Date:2024-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY353915363LF0000X
PASP022778363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily