Healthcare Provider Details

I. General information

NPI: 1912825753
Provider Name (Legal Business Name): ALYSSA CASE LEWMAN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/08/2026
Last Update Date: 07/08/2026
Certification Date: 07/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1200 N STATE ST STE 270
JACKSON MS
39202-2027
US

IV. Provider business mailing address

138 OAK GROVE DR
BRANDON MS
39047-6805
US

V. Phone/Fax

Practice location:
  • Phone: 601-714-6470
  • Fax:
Mailing address:
  • Phone: 601-754-3471
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number908506
License Number StateMS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: