MEDICARE: KIMBERLY NICOLE LEWIS

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	363LP0808X	Psychiatric/Mental Health Nurse Practitioner	95033804	CA

General Provider Information

NPI Number	:	1568896454
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KIMBERLY NICOLE LEWIS

Provider Business Mailing Address
First Line	:	9671 IRIS MEADOW WAY
Second Line	:
City	:	ELK GROVE
State	:	CA
Zip	:	95757-3227
Country	:	US
Telephone Number	:	510-759-9628
Fax Number	:

Provider Business Practice Location Address
First Line	:	717 K ST STE 425
Second Line	:
City	:	SACRAMENTO
State	:	CA
Zip	:	95814-3477
Country	:	US
Telephone Number	:	916-793-9823
Fax Number	:

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

Provider Enumeration Date	:	08/27/2013
Last Update Date	:	02/13/2025

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Directions to “ KIMBERLY NICOLE LEWIS ” Practice Location

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