Healthcare Provider Details

I. General information

NPI: 1902181258
Provider Name (Legal Business Name): SANDRA JEAN ALEXANDER-LEWIS MSN, FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/19/2011
Last Update Date: 06/13/2024
Certification Date: 05/08/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 MEDICAL VILLAGE DR
EDGEWOOD KY
41017-3403
US

IV. Provider business mailing address

111 RIVERVIEW DRIVE P.O. BOX 1269
WARSAW KY
41095
US

V. Phone/Fax

Practice location:
  • Phone: 859-301-8074
  • Fax: 859-301-4945
Mailing address:
  • Phone: 812-801-9535
  • Fax: 859-567-2758

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number71003738A
License Number StateIN
# 2
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAPRN.CNP.024954
License Number StateOH
# 3
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number3007359
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: