Healthcare Provider Details

I. General information

NPI: 1700642238
Provider Name (Legal Business Name): KAITLIN LEWING ATC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/22/2024
Last Update Date: 09/10/2026
Certification Date: 09/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1701 OAK PARK BLVD
LAKE CHARLES LA
70601-8911
US

IV. Provider business mailing address

350 PINE ST
MANY LA
71449-2828
US

V. Phone/Fax

Practice location:
  • Phone: 337-494-3000
  • Fax:
Mailing address:
  • Phone: 318-471-0619
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License Number343848
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: