MEDICARE: KIAYONNA 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	164W00000X	Licensed Practical Nurse	156413	OH
2	101YM0800X	Mental Health Counselor		OH

General Provider Information

NPI Number	:	1881138659
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KIAYONNA LEWIS

Provider Business Mailing Address
First Line	:	1802 BALTIMORE AVE
Second Line	:
City	:	CINCINNATI
State	:	OH
Zip	:	45225-1903
Country	:	US
Telephone Number	:	513-373-8980
Fax Number	:

Provider Business Practice Location Address
First Line	:	813 TROY ST
Second Line	:
City	:	DAYTON
State	:	OH
Zip	:	45404-1852
Country	:	US
Telephone Number	:	937-982-1500
Fax Number	:	937-982-1500

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

Provider Enumeration Date	:	12/13/2016
Last Update Date	:	02/08/2026

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Directions to “ KIAYONNA LEWIS ” Practice Location

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