MEDICARE: MRS. REBEKA LINN LEWIS MSN, APRN, PMHNP-BC

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	363LP0808X	Psychiatric/Mental Health Nurse Practitioner	12923233-4405	UT
2	363LP0808X	Psychiatric/Mental Health Nurse Practitioner	875374	NV

General Provider Information

NPI Number	:	1356104913
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. REBEKA LINN LEWIS MSN, APRN, PMHNP-BC

Provider Business Mailing Address
First Line	:	1664 S DIXIE DR STE E102
Second Line	:
City	:	ST GEORGE
State	:	UT
Zip	:	84770-7329
Country	:	US
Telephone Number	:	435-703-9647
Fax Number	:

Provider Business Practice Location Address
First Line	:	840 PINNACLE CT STE 8A
Second Line	:
City	:	MESQUITE
State	:	NV
Zip	:	89027-3322
Country	:	US
Telephone Number	:	435-703-9647
Fax Number	:	435-703-6003

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

Provider Enumeration Date	:	02/05/2024
Last Update Date	:	01/29/2025

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