Healthcare Provider Details

I. General information

NPI: 1518754449
Provider Name (Legal Business Name): SCOTT R LEWIS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/23/2025
Last Update Date: 09/08/2026
Certification Date: 09/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

809 W MAIN ST STE C
MONROE WA
98272-2172
US

IV. Provider business mailing address

1212 N STEELE ST
TACOMA WA
98406-8006
US

V. Phone/Fax

Practice location:
  • Phone: 206-552-0882
  • Fax:
Mailing address:
  • Phone: 619-203-0860
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberARNP.AP.70146522-NP
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: