Healthcare Provider Details

I. General information

NPI: 1659160133
Provider Name (Legal Business Name): JERRIKA M LEWIS FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/02/2025
Last Update Date: 05/02/2025
Certification Date: 05/02/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4401 E LOHMAN AVE
LAS CRUCES NM
88011-8267
US

IV. Provider business mailing address

4311 E LOHMAN AVE
LAS CRUCES NM
88011-8255
US

V. Phone/Fax

Practice location:
  • Phone: 575-522-0116
  • Fax: 575-522-0094
Mailing address:
  • Phone: 575-556-7600
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number83334
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: