Healthcare Provider Details

I. General information

NPI: 1679494751
Provider Name (Legal Business Name): AHLICIA AARION LEWIS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/23/2026
Last Update Date: 07/23/2026
Certification Date: 07/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

910 E 33RD ST N
TULSA OK
74106-1943
US

IV. Provider business mailing address

910 E 33RD ST N
TULSA OK
74106-1943
US

V. Phone/Fax

Practice location:
  • Phone: 918-752-4631
  • Fax:
Mailing address:
  • Phone: 918-752-4631
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code175T00000X
TaxonomyPeer Specialist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: