MEDICARE: MS. KATHERINE JANIS LEWIS APRN

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	207Q00000X	Family Medicine Physician	R50938	AR

General Provider Information

NPI Number	:	1225093123
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. KATHERINE JANIS LEWIS APRN

Provider Business Mailing Address
First Line	:	4206 FRAZIER PIKE
Second Line	:
City	:	LITTLE ROCK
State	:	AR
Zip	:	72206-9635
Country	:	US
Telephone Number	:	501-490-2440
Fax Number	:	501-490-0156

Provider Business Practice Location Address
First Line	:	4206 FRAZIER PIKE
Second Line	:
City	:	LITTLE ROCK
State	:	AR
Zip	:	72206-9635
Country	:	US
Telephone Number	:	501-490-2440
Fax Number	:	501-490-0156

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

Provider Enumeration Date	:	04/20/2006
Last Update Date	:	10/22/2012

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