Healthcare Provider Details

I. General information

NPI: 1770968844
Provider Name (Legal Business Name): KAYANA IEISHA-MARIE LEWIS M.S.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: KAYANA IEISHA-MARIE SANDERS

II. Dates (important events)

Enumeration Date: 07/29/2015
Last Update Date: 12/10/2019
Certification Date: 12/10/2019
Deactivation Date:
Reactivation Date:

III. Provider practice location address

630 S RANCHO DR STE A
LAS VEGAS NV
89106-4849
US

IV. Provider business mailing address

3016 W CHARLESTON BLVD STE 205
LAS VEGAS NV
89102-1963
US

V. Phone/Fax

Practice location:
  • Phone: 702-998-9505
  • Fax: 702-527-7939
Mailing address:
  • Phone: 702-780-2315
  • Fax: 702-895-4014

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License NumberRBT-18-52418
License Number StateNV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: