Healthcare Provider Details

I. General information

NPI: 1194453902
Provider Name (Legal Business Name): HEATHER MARIE LEWIS FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: MRS. HEATHER MARIE FOWLER

II. Dates (important events)

Enumeration Date: 08/10/2022
Last Update Date: 07/23/2026
Certification Date: 07/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1401 JOHNSTON WILLIS DR STE 100
NORTH CHESTERFIELD VA
23235-4730
US

IV. Provider business mailing address

7202 GLEN FOREST DR STE 200
RICHMOND VA
23226-3780
US

V. Phone/Fax

Practice location:
  • Phone: 804-330-7990
  • Fax: 804-330-3541
Mailing address:
  • Phone: 804-673-0134
  • Fax: 804-200-6229

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number0024184793
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: