Healthcare Provider Details

I. General information

NPI: 1992614275
Provider Name (Legal Business Name): ADRIA LEWIS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/03/2026
Last Update Date: 09/03/2026
Certification Date: 09/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

155 WELLNESS WAY
STATE COLLEGE PA
16803-6702
US

IV. Provider business mailing address

517 N 9TH ST
PHILIPSBURG PA
16866-1011
US

V. Phone/Fax

Practice location:
  • Phone: 814-278-4851
  • Fax:
Mailing address:
  • Phone: 814-577-2592
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberOA007880
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: