MEDICARE: KENYA LEWIS RN, CDE

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	163WD0400X	Diabetes Educator Registered Nurse	21700521	VA

General Provider Information

NPI Number	:	1356919633
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KENYA LEWIS RN, CDE

Provider Business Mailing Address
First Line	:	7818 LITTLE RIDGE CT
Second Line	:
City	:	CHESTERFIELD
State	:	VA
Zip	:	23832-7775
Country	:	US
Telephone Number	:	804-334-1309
Fax Number	:

Provider Business Practice Location Address
First Line	:	705 TWINRIDGE LN STE 6
Second Line	:
City	:	NORTH CHESTERFIELD
State	:	VA
Zip	:	23235-5270
Country	:	US
Telephone Number	:	804-320-1220
Fax Number	:

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

Provider Enumeration Date	:	06/14/2021
Last Update Date	:	06/14/2021

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