Basic Information
| Provider Information | |||||||||
| NPI: | 1346968146 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | LEWIS | ||||||||
| FirstName: | ANNA | ||||||||
| MiddleName: | CATHERINE | ||||||||
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| Credential: | FNP-C | ||||||||
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| Mailing Information | |||||||||
| Address1: | 415 JACKSON STEPHENS RD | ||||||||
| Address2: | |||||||||
| City: | DE KALB | ||||||||
| State: | MS | ||||||||
| PostalCode: | 393287521 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6015626359 | ||||||||
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| Practice Location | |||||||||
| Address1: | 1017 W BEACON ST | ||||||||
| Address2: | |||||||||
| City: | PHILADELPHIA | ||||||||
| State: | MS | ||||||||
| PostalCode: | 393503218 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7692000730 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 08/17/2022 | ||||||||
| LastUpdateDate: | 08/17/2022 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 08/01/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363LF0000X | 905481 | MS | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Family |
No ID Information.