Kathleen Lewis, PMHNP-BC

Key facts

NPI

1104416692

Entity type

Individual (NPI type 1)

Primary specialty

Psychiatric/Mental Health Nurse Practitioner 363LP0808X

License

R208736 (MD)

Practice address

25 Joan Dr
York, PA 17404-8289

Phone

(717) 487-7107

NPI assigned

Jan 19, 2021

Sex

Female

Sole proprietor

Yes

Organizations & group practices 2

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• ABA Health Services Inc Mental Health Clinic/Center (Including Community Mental Health Center) · Baltimore, MD · NPI 1720019672
  Medicare reassignment NPD MD
• ABA Health Services Counseling Substance Use Disorder Rehabilitation Clinic/Center · Baltimore, MD · NPI 1649593245
  NPD (past)

Medicare Care Compare profile

Specialty

Nurse Practitioner

Education

Other, 2020

Medicare assignment

May accept Medicare assignment

Practice addresses (Care Compare)

Medicare participation

Medicare fee-for-service enrollment

Enrolled in MD

Eligible to order & refer

Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: Yes · Hospice: No

Medicare enrollment records

National Provider Directory

Medicare enrollment (NPD)

Yes

Credentials

Nurse Practitioner

State licenses

Practice roles

Locations

Specialties & licenses

Addresses

The complete NPPES record for this NPI in the NPI Registry API JSON format, last updated by the provider on Aug 11, 2021.

{
    "created_epoch": "1611014400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1628640000000",
    "number": "1104416692",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "25 JOAN DR",
            "city": "YORK",
            "state": "PA",
            "postal_code": "174048289",
            "telephone_number": "717-487-7107"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "25 JOAN DR",
            "city": "YORK",
            "state": "PA",
            "postal_code": "174048289",
            "telephone_number": "717-487-7107"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "LEWIS",
        "first_name": "KATHLEEN",
        "credential": "PMHNP-BC",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2021-01-19",
        "last_updated": "2021-08-11",
        "certification_date": "2021-08-11",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LP0808X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Psychiatric/Mental Health",
            "state": "MD",
            "license": "R208736",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Shantelle Sharee Lewis, PTA
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All providers in York, PA · Psychiatric/Mental Health Nurse Practitioner in Pennsylvania