Healthcare Provider Details

I. General information

NPI: 1821668153
Provider Name (Legal Business Name): JERRI LEWIS RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/29/2021
Last Update Date: 06/29/2021
Certification Date: 06/29/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3625 FERN VALLEY RD
LOUISVILLE KY
40219-1916
US

IV. Provider business mailing address

3625 FERN VALLEY RD
LOUISVILLE KY
40219-1916
US

V. Phone/Fax

Practice location:
  • Phone: 502-964-3381
  • Fax: 502-759-5049
Mailing address:
  • Phone: 502-964-3381
  • Fax: 502-759-5049

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code364SL0600X
TaxonomyLong-Term Care Clinical Nurse Specialist
License Number1122150
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: