Healthcare Provider Details

I. General information

NPI: 1720865306
Provider Name (Legal Business Name): MS. LORRAINE JODY-ANN LEWIS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/08/2023
Last Update Date: 12/17/2025
Certification Date: 12/17/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4385 NARROW LANE RD
MONTGOMERY AL
36116-2978
US

IV. Provider business mailing address

4171 LOMAC ST STE F
MONTGOMERY AL
36106-2945
US

V. Phone/Fax

Practice location:
  • Phone: 334-801-8134
  • Fax:
Mailing address:
  • Phone: 334-578-7448
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LW0102X
TaxonomyWomen's Health Nurse Practitioner
License NumberGAA-NP004211
License Number StateGA
# 2
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number1-179771
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: