Healthcare Provider Details

I. General information

NPI: 1770416612
Provider Name (Legal Business Name): KERIONNE LEWIS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/08/2026
Last Update Date: 06/08/2026
Certification Date: 06/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

451 E AIRPORT AVE STE A
BATON ROUGE LA
70806-4853
US

IV. Provider business mailing address

2410 AMY DR
LA PLACE LA
70068-6267
US

V. Phone/Fax

Practice location:
  • Phone: 504-517-4820
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code374J00000X
TaxonomyDoula
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: