Healthcare Provider Details

I. General information

NPI: 1104662386
Provider Name (Legal Business Name): KOURTNY DEANA LEWIS PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/08/2024
Last Update Date: 10/14/2025
Certification Date: 10/14/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5710 SILVER HILL RD
DISTRICT HEIGHTS MD
20747-1101
US

IV. Provider business mailing address

7903 PRENTICE CT
FORT WASHINGTON MD
20744-4449
US

V. Phone/Fax

Practice location:
  • Phone: 301-736-7000
  • Fax:
Mailing address:
  • Phone: 240-605-3833
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberC0010076
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: