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NPI Code Detail

MEDICARE: JASMINE MADELINE LEWIS PMHNP-BC

MEDICARE: JASMINE MADELINE LEWIS PMHNP-BC
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
1363LP0808XPsychiatric/Mental Health Nurse PractitionerAPRN11044737FL
2363LP0808XPsychiatric/Mental Health Nurse Practitioner10056681OR

General Provider Information

NPI Number : 1669330395
Entity Type Code : Individual
Provider Name (Legal Business Name) : JASMINE MADELINE LEWIS PMHNP-BC
Provider Business Mailing Address
First Line : 249 CITADEL LN
Second Line :
City : CRESTVIEW
State : FL
Zip : 32539-4360
Country : US
Telephone Number : 850-902-3770
Fax Number :
Provider Business Practice Location Address
First Line : 535 SE WASHINGTON ST
Second Line :
City : HILLSBORO
State : OR
Zip : 97123-4142
Country : US
Telephone Number : 850-902-3770
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 01/12/2026
Last Update Date : 03/10/2026

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