=====================================================
General NPI Number Information
=====================================================
NPI Number | 1932311248
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | JAIME LYNN LEWIS RD, LDN
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/07/2007
-----------------------------------------------------
Last Update Date | 08/31/2020
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 147 NC HIGHWAY 24 STE 101
-----------------------------------------------------
City | MOREHEAD CITY
-----------------------------------------------------
State | NC
-----------------------------------------------------
Zip | 28557-8982
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 252-648-8777
-----------------------------------------------------
Fax | 252-648-8087
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 300 KATHRYN CT
-----------------------------------------------------
City | NEWPORT
-----------------------------------------------------
State | NC
-----------------------------------------------------
Zip | 28570-9612
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 252-342-8678
-----------------------------------------------------
Fax | 252-444-4026
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 133V00000X
-----------------------------------------------------
Taxonomy Name | Registered Dietitian
-----------------------------------------------------
License Number | 910311
-----------------------------------------------------
License Number State | NC
-----------------------------------------------------