MEDICARE: KRISTINE RENEE' LEWIS PA-C

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	363A00000X	Physician Assistant	101600	NC

General Provider Information

NPI Number	:	1598746547
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KRISTINE RENEE' LEWIS PA-C

Provider Business Mailing Address
First Line	:	126 LAKEVIEW CIR
Second Line	:
City	:	WARSAW
State	:	NC
Zip	:	28398-9589
Country	:	US
Telephone Number	:	910-293-3619
Fax Number	:

Provider Business Practice Location Address
First Line	:	600 SOUTH SYCAMORE STREET
Second Line	:
City	:	ROSE HILL
State	:	NC
Zip	:	28458
Country	:	US
Telephone Number	:	910-289-3027
Fax Number	:	910-289-2894

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

Provider Enumeration Date	:	11/08/2005
Last Update Date	:	07/18/2024

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