Healthcare Provider Details

I. General information

NPI: 1285562801
Provider Name (Legal Business Name): CASSANDRA DENISE LEWIS PMHNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/12/2026
Last Update Date: 05/12/2026
Certification Date: 05/12/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3644 KERRY ANN WAY
JEFFERSONVILLE IN
47130-8669
US

IV. Provider business mailing address

3644 KERRY ANN WAY
JEFFERSONVILLE IN
47130-8669
US

V. Phone/Fax

Practice location:
  • Phone: 850-530-3430
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LS0200X
TaxonomySchool Nurse Practitioner
License Number28266384A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: