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General NPI Number Information
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NPI Number | 1265839690
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Entity Type | Individual
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Provider Name | RYAN LEWIS
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Gender | Male
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Dates
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Enumeration Date | 12/01/2014
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Last Update Date | 12/01/2014
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Provider Practice Location Address
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Address Line | 202 STATE ST STE A
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City | FORT SCOTT
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State | KS
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Zip | 66701-2031
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Country | US
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Telephone | 417-321-2845
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Fax |
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Provider Business Mailing Address
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Address Line | 903 BURKE ST
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City | FORT SCOTT
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State | KS
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Zip | 66701-2411
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Country | US
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Telephone | 417-321-2845
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | 150273
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License Number State | KS
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