MEDICARE: KAITLYN LEWIS

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	363LF0000X	Family Nurse Practitioner	5024298	NC

General Provider Information

NPI Number	:	1619810272
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KAITLYN LEWIS

Provider Business Mailing Address
First Line	:	933 DODSON MILL RD
Second Line	:
City	:	PILOT MOUNTAIN
State	:	NC
Zip	:	27041-9372
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	910 WORTH ST
Second Line	:
City	:	MOUNT AIRY
State	:	NC
Zip	:	27030-4458
Country	:	US
Telephone Number	:	336-786-5108
Fax Number	:

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

Provider Enumeration Date	:	04/09/2026
Last Update Date	:	04/09/2026

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Directions to “ KAITLYN LEWIS ” Practice Location

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