MEDICARE: RICKY L LEWIS CRNP

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	363L00000X	Nurse Practitioner	1-061464	AL

General Provider Information

NPI Number	:	1194747584
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	RICKY L LEWIS CRNP

Provider Business Mailing Address
First Line	:	PO BOX 398
Second Line	:
City	:	ANDALUSIA
State	:	AL
Zip	:	36420-1207
Country	:	US
Telephone Number	:	334-222-8421
Fax Number	:	334-222-1248

Provider Business Practice Location Address
First Line	:	835 S THREE NOTCH ST
Second Line	:
City	:	ANDALUSIA
State	:	AL
Zip	:	36420-5321
Country	:	US
Telephone Number	:	334-222-8421
Fax Number	:	334-222-1248

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

Provider Enumeration Date	:	07/24/2006
Last Update Date	:	07/08/2007

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