Healthcare Provider Details

I. General information

NPI: 1477404101
Provider Name (Legal Business Name): JACK CHRISTOPHER LEWIS RN
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/09/2026
Last Update Date: 04/16/2026
Certification Date: 04/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

160 OLD DERBY ST STE 457
HINGHAM MA
02043-4062
US

IV. Provider business mailing address

160 OLD DERBY ST STE 457
HINGHAM MA
02043-4062
US

V. Phone/Fax

Practice location:
  • Phone: 781-837-8833
  • Fax: 781-735-0457
Mailing address:
  • Phone: 781-837-8833
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WP0809X
TaxonomyAdult Psychiatric/Mental Health Registered Nurse
License NumberRN2385743
License Number StateMA
# 2
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberRN2385743
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: