Healthcare Provider Details

I. General information

NPI: 1184180663
Provider Name (Legal Business Name): EMILY LEWIS PA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: EMILY FARRELL PA

II. Dates (important events)

Enumeration Date: 02/20/2019
Last Update Date: 12/17/2025
Certification Date: 12/17/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

65 VILLAGE SQUARE DR STE 201
SOUTH KINGSTOWN RI
02879-2569
US

IV. Provider business mailing address

15 LA SALLE SQ
PROVIDENCE RI
02903-1814
US

V. Phone/Fax

Practice location:
  • Phone: 401-444-7959
  • Fax: 401-515-7910
Mailing address:
  • Phone: 401-443-5112
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License NumberPA01508
License Number StateRI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: