Healthcare Provider Details

I. General information

NPI: 1891513123
Provider Name (Legal Business Name): CANDICE LEWIS RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/26/2024
Last Update Date: 05/26/2026
Certification Date: 05/26/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4240 BLUE RIDGE BLVD STE 410
KANSAS CITY MO
64133-1706
US

IV. Provider business mailing address

833 ROCK CREEK DR
LANSING KS
66043-7300
US

V. Phone/Fax

Practice location:
  • Phone: 913-547-3494
  • Fax: 833-970-2362
Mailing address:
  • Phone: 913-547-3494
  • Fax: 833-970-2362

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number53-85399-111
License Number StateKS
# 2
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number2026014655
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: