Healthcare Provider Details

I. General information

NPI: 1245979012
Provider Name (Legal Business Name): MEGAN LEWIS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/31/2022
Last Update Date: 09/10/2024
Certification Date: 08/22/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

79 SAND PEBBLE DR
JACKSON TN
38305-7591
US

IV. Provider business mailing address

219 SUNNYSIDE DR
JACKSON TN
38301-3301
US

V. Phone/Fax

Practice location:
  • Phone: 855-444-5664
  • Fax:
Mailing address:
  • Phone: 731-336-9692
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number1606
License Number StateTN
# 2
Primary TaxonomyN
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License NumberRBT-21-173496
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: