Healthcare Provider Details

I. General information

NPI: 1255315883
Provider Name (Legal Business Name): SHAUNDA L. LEWIS A.P.R.N., B.C.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/06/2005
Last Update Date: 05/24/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

644 HIGHWAY 114 S
SCOTTS HILL TN
38374-5023
US

IV. Provider business mailing address

644 HIGHWAY 114 S P. O. BOX 99
SCOTTS HILL TN
38374-5023
US

V. Phone/Fax

Practice location:
  • Phone: 731-549-3191
  • Fax: 731-549-3005
Mailing address:
  • Phone: 731-549-3191
  • Fax: 731-549-3005

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP2300X
TaxonomyPrimary Care Nurse Practitioner
License NumberAPN0000005099
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: