Healthcare Provider Details

I. General information

NPI: 1821070053
Provider Name (Legal Business Name): LUCREASIE LEWIS ARNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/15/2005
Last Update Date: 01/28/2020
Certification Date: 01/28/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

441 GORMAN HOLLOW RD
HAZARD KY
41701-2315
US

IV. Provider business mailing address

441 GORMAN HOLLOW RD
HAZARD KY
41701-2315
US

V. Phone/Fax

Practice location:
  • Phone: 606-439-2361
  • Fax: 606-439-0870
Mailing address:
  • Phone: 606-439-2361
  • Fax: 606-439-0870

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WC1500X
TaxonomyCommunity Health Registered Nurse
License Number1058965
License Number StateKY
# 2
Primary TaxonomyY
Taxonomy Code363LW0102X
TaxonomyWomen's Health Nurse Practitioner
License Number2973P
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: