MEDICARE: TAYLOR LEWIS APRN-CNP

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	163WX0003X	Inpatient Obstetric Registered Nurse	112042	OK
2	363LF0000X	Family Nurse Practitioner	R0112042	OK

General Provider Information

NPI Number	:	1992277297
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TAYLOR LEWIS APRN-CNP

Provider Business Mailing Address
First Line	:	2703 N 14TH ST
Second Line	:
City	:	PONCA CITY
State	:	OK
Zip	:	74601-1738
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	2703 N 14TH ST
Second Line	:
City	:	PONCA CITY
State	:	OK
Zip	:	74601-1738
Country	:	US
Telephone Number	:	580-765-9451
Fax Number	:

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

Provider Enumeration Date	:	12/26/2018
Last Update Date	:	05/13/2024

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