Healthcare Provider Details

I. General information

NPI: 1609156256
Provider Name (Legal Business Name): JENNIFER E LEWIS DNP APRN CNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/26/2011
Last Update Date: 08/18/2021
Certification Date: 08/17/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

825 NE 10TH ST STE 5400
OKLAHOMA CITY OK
73104-5417
US

IV. Provider business mailing address

825 NE 10TH ST STE 5F
OKLAHOMA CITY OK
73104-5417
US

V. Phone/Fax

Practice location:
  • Phone: 405-271-8156
  • Fax: 405-271-9358
Mailing address:
  • Phone: 405-271-8156
  • Fax: 405-271-6219

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number84880
License Number StateOK
# 2
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberR0084880
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: