Healthcare Provider Details

I. General information

NPI: 1306785019
Provider Name (Legal Business Name): TIMOTHY LEWIS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/26/2026
Last Update Date: 03/26/2026
Certification Date: 03/26/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5313 HWY 5 SUITE 5 #1015
BRYANT AR
72022
US

IV. Provider business mailing address

5313 HWY 5 SUITE 5 #1015
BRYANT AR
72022
US

V. Phone/Fax

Practice location:
  • Phone: 501-287-4434
  • Fax:
Mailing address:
  • Phone: 501-287-4434
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code347C00000X
TaxonomyPrivate Vehicle
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: