Healthcare Provider Details

I. General information

NPI: 1356919633
Provider Name (Legal Business Name): KENYA LEWIS RN, CDE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/14/2021
Last Update Date: 06/14/2021
Certification Date: 06/14/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

705 TWINRIDGE LN STE 6
NORTH CHESTERFIELD VA
23235-5270
US

IV. Provider business mailing address

7818 LITTLE RIDGE CT
CHESTERFIELD VA
23832-7775
US

V. Phone/Fax

Practice location:
  • Phone: 804-320-1220
  • Fax:
Mailing address:
  • Phone: 804-334-1309
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WD0400X
TaxonomyDiabetes Educator Registered Nurse
License Number21700521
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: