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NPI Code Detail

MEDICARE: ERIN NICHOLE WHITLEY-LEWIS

MEDICARE: ERIN NICHOLE WHITLEY-LEWIS
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1106S00000XBehavior Technician

General Provider Information

NPI Number : 1104633015
Entity Type Code : Individual
Provider Name (Legal Business Name) : ERIN NICHOLE WHITLEY-LEWIS
Provider Business Mailing Address
First Line : 165 SCOTLAND YARD BLVD
Second Line :
City : SAINT JOHNS
State : FL
Zip : 32259-5913
Country : US
Telephone Number : 904-605-0614
Fax Number :
Provider Business Practice Location Address
First Line : 7121 E MOUNT VERNON ST
Second Line :
City : GLEN SAINT MARY
State : FL
Zip : 32040-5085
Country : US
Telephone Number : 904-605-0614
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 12/13/2024
Last Update Date : 12/13/2024

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Directions to “ ERIN NICHOLE WHITLEY-LEWIS ” Practice Location

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