Healthcare Provider Details

I. General information

NPI: 1215415260
Provider Name (Legal Business Name): TAMMY J LEWIS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/01/2018
Last Update Date: 12/09/2024
Certification Date: 12/09/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

103 CAMPUS DR
ANNVILLE KY
40402-8271
US

IV. Provider business mailing address

PO BOX 214
ANNVILLE KY
40402-0214
US

V. Phone/Fax

Practice location:
  • Phone: 606-824-4005
  • Fax: 859-813-5394
Mailing address:
  • Phone: 606-824-4005
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: