MEDICARE: KRYSTAL LYNN LEWIS NP

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	28207167A	IN

General Provider Information

NPI Number	:	1386484533
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KRYSTAL LYNN LEWIS NP

Provider Business Mailing Address
First Line	:	3410 N HIGH SCHOOL RD STE G
Second Line	:
City	:	INDIANAPOLIS
State	:	IN
Zip	:	46224-1100
Country	:	US
Telephone Number	:	317-721-8679
Fax Number	:

Provider Business Practice Location Address
First Line	:	3410 N HIGH SCHOOL RD STE G
Second Line	:
City	:	INDIANAPOLIS
State	:	IN
Zip	:	46224-1100
Country	:	US
Telephone Number	:	317-721-8679
Fax Number	:

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

Provider Enumeration Date	:	05/27/2024
Last Update Date	:	04/15/2025

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