Healthcare Provider Details

I. General information

NPI: 1073055695
Provider Name (Legal Business Name): KAYLON LEWIS CNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/14/2016
Last Update Date: 04/24/2026
Certification Date: 04/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

201 E LAYFAIR DR STE 120
FLOWOOD MS
39232-7604
US

IV. Provider business mailing address

201 E LAYFAIR DR STE 120
FLOWOOD MS
39232-7604
US

V. Phone/Fax

Practice location:
  • Phone: 601-750-1259
  • Fax:
Mailing address:
  • Phone: 601-414-9263
  • Fax: 601-414-9269

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number901809
License Number StateMS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: