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General NPI Number Information
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NPI Number | 1821355454
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Entity Type | Individual
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Provider Name | COREY LEWIS PA
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Gender | Male
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Dates
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Enumeration Date | 04/20/2012
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Last Update Date | 06/17/2025
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Provider Practice Location Address
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Address Line | 3181 SW SAM JACKSON PARK RD
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City | PORTLAND
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State | OR
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Zip | 97239-3011
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Country | US
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Telephone | 503-494-4373
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Fax |
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Provider Business Mailing Address
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Address Line | 210 E ECONOMY RD
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City | MORRISTOWN
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State | TN
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Zip | 37814-3756
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Country | US
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Telephone | 423-307-1468
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Fax | 423-307-1479
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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 | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | PA2126
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License Number State | TN
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Taxonomy #2
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | PA.0006653
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License Number State | CO
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Taxonomy #3
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Taxonomy Code | 363AS0400X
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Taxonomy Name | Surgical Physician Assistant
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License Number | PA218898
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License Number State | OR
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