MEDICARE: MELYSSA LEWIS DNP, BSN, CPNP-PC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363L00000X	Nurse Practitioner	225129	OK
2	163WE0003X	Emergency Registered Nurse	259493	AZ
3	363LP0200X	Pediatric Nurse Practitioner	259493	AZ
4	163WP0200X	Pediatric Registered Nurse	RN60945219	WA

General Provider Information

NPI Number	:	1265044747
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MELYSSA LEWIS DNP, BSN, CPNP-PC

Provider Business Mailing Address
First Line	:	9480 N MAY AVE
Second Line	:
City	:	OKLAHOMA CITY
State	:	OK
Zip	:	73120-2712
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	9480 N MAY AVE
Second Line	:
City	:	OKLAHOMA CITY
State	:	OK
Zip	:	73120-2712
Country	:	US
Telephone Number	:	405-876-7876
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/17/2020
Last Update Date	:	10/25/2025

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