Healthcare Provider Details

I. General information

NPI: 1518323427
Provider Name (Legal Business Name): VIRGINIA DENISE LEWIS PMHNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: VIRGINIA DENISE PERRY RN

II. Dates (important events)

Enumeration Date: 01/07/2016
Last Update Date: 06/11/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3450 HIGHWAY 80 W
JACKSON MS
39209-7201
US

IV. Provider business mailing address

PO BOX 157A 3550 HIGHWAY 468 WEST
WHITFIELD MS
39193-0157
US

V. Phone/Fax

Practice location:
  • Phone: 601-321-2400
  • Fax: 601-985-5174
Mailing address:
  • Phone: 601-351-8000
  • Fax: 601-351-8586

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number901385
License Number StateMS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: