Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LP0808X | Nurse Practitioner - Psychiatric/Mental Health | APN0000020059 | TN |
NPI | 1033585427 |
---|---|
Provider Name | Brent Lewis |
First Address | Paris, TN 38242-5341 |
Second Address | Trenton, TN 38382-4006 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 19/08/2015 |
Last Update Date | 05/02/2019 |