Healthcare Provider Details

I. General information

NPI: 1801997226
Provider Name (Legal Business Name): AMANDA L LEWIS PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/26/2006
Last Update Date: 08/17/2026
Certification Date: 08/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

288 S PACIFIC HWY
TALENT OR
97540-6649
US

IV. Provider business mailing address

288 S PACIFIC HWY
TALENT OR
97540-6649
US

V. Phone/Fax

Practice location:
  • Phone: 304-520-6644
  • Fax: 541-414-0415
Mailing address:
  • Phone: 541-500-4199
  • Fax: 541-414-0415

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number2181
License Number StateAZ
# 2
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA217673
License Number StateOR
# 3
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number4185
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: