Healthcare Provider Details

I. General information

NPI: 1366871030
Provider Name (Legal Business Name): CARRIE ELIZABETH LEWEY PA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/04/2013
Last Update Date: 02/07/2020
Certification Date: 02/07/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5123 VIRGINIA WAY STE B11
BRENTWOOD TN
37027-7519
US

IV. Provider business mailing address

775 WEATHERLY DR STE F
CLARKSVILLE TN
37043-8942
US

V. Phone/Fax

Practice location:
  • Phone: 615-445-7600
  • Fax: 615-332-8939
Mailing address:
  • Phone: 423-794-5520
  • Fax: 423-282-0720

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number2429
License Number StateTN
# 2
Primary TaxonomyN
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number2429
License Number StateTN
# 3
Primary TaxonomyN
Taxonomy Code363AS0400X
TaxonomySurgical Physician Assistant
License Number2429
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: