MEDICARE: MS. KEELIN R LEWIS PA-C

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
1	390200000X	Student in an Organized Health Care Education/Training Program
2	363A00000X	Physician Assistant	PA.0007395	CO

General Provider Information

NPI Number	:	1134732076
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. KEELIN R LEWIS PA-C

Provider Business Mailing Address
First Line	:	526 29 1/2 RD
Second Line	:
City	:	GRAND JUNCTION
State	:	CO
Zip	:	81504-5383
Country	:	US
Telephone Number	:	970-200-1600
Fax Number	:	970-692-8301

Provider Business Practice Location Address
First Line	:	526 29 1/2 RD
Second Line	:
City	:	GRAND JUNCTION
State	:	CO
Zip	:	81504-5383
Country	:	US
Telephone Number	:	970-200-1600
Fax Number	:	970-692-8301

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/29/2020
Last Update Date	:	01/16/2026

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