Andrea Morgan Formyduval Lewis, FNP

Primary specialty

Family Nurse PractitionerTaxonomy code 363LF0000X

License

5004417 Issued in NC

Practice address

4005 Oleander Dr
Wilmington, NC 28403-6816

Phone

(910) 790-9949

Fax

(910) 790-9455

NPI assigned

Jul 13, 2009

Last updated

Aug 14, 2023By the provider in NPPES

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in NC

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

Credentials

Nurse Practitioner

Practice roles

Locations

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

• Coastal Horizons Center, Inc.

  • Community/Behavioral Health Agency
  • Wilmington, NC
  • NPI 1922022607
  Medicare reassignment NPD
• Coastal Horizons Center Inc

  • Community/Behavioral Health Agency
  • Rocky Point, NC
  • NPI 1063082592
  NPD
• Coastal Horizons Center, Inc.

  • Community/Behavioral Health Agency
  • Wilmington, NC
  • NPI 1790985448
  NPD
• Coastal Horizons Center, Inc.

  • Community/Behavioral Health Agency
  • Wilmington, NC
  • NPI 1992905640
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1247443200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1691971200000",
    "number": "1154550077",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "615 SHIPYARD BLVD",
            "city": "WILMINGTON",
            "state": "NC",
            "postal_code": "284126431",
            "telephone_number": "910-343-0145",
            "fax_number": "910-790-9455"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4005 OLEANDER DR",
            "city": "WILMINGTON",
            "state": "NC",
            "postal_code": "284036816",
            "telephone_number": "910-790-9949",
            "fax_number": "910-790-9455"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "2700 N College Rd",
            "address_purpose": "LOCATION",
            "city": "Wilmington",
            "state": "NC",
            "postal_code": "284058816",
            "country_code": "US",
            "telephone_number": "910-790-9949",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "555 Halyburton Pkwy",
            "address_purpose": "LOCATION",
            "city": "Wilmington",
            "state": "NC",
            "postal_code": "284123094",
            "country_code": "US",
            "telephone_number": "910-790-9949",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "613 Shipyard Blvd",
            "address_purpose": "LOCATION",
            "city": "Wilmington",
            "state": "NC",
            "postal_code": "284126492",
            "country_code": "US",
            "telephone_number": "910-202-3860",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "1307 Market St",
            "address_purpose": "LOCATION",
            "city": "Wilmington",
            "state": "NC",
            "postal_code": "284014331",
            "country_code": "US",
            "telephone_number": "910-790-9949",
            "fax_number": "910-790-9455",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "FORMYDUVAL LEWIS",
        "first_name": "ANDREA",
        "middle_name": "MORGAN",
        "credential": "FNP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2009-07-13",
        "last_updated": "2023-08-14",
        "certification_date": "2023-08-14",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "NC",
            "license": "5004417",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "7005679",
            "state": "NC"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Mary Leigh Forehand
• Constance Foreman, MD
• Matthew Abbitt Foreman, CRNA
• Michelle Romano Foreman, CRNA
• Anna Marie Formichella
• Amy Landis Formyduval
• James Summers Forrester Jr., MD
• Lorraine M Forris, MSW, LCSW
• Brittany Forshay, MD
• Forsyth Medical Group, LLC (Robison Advanced GYN Solutions)

• Family Nurse Practitioner in Wilmington, NC
• Providers in Wilmington, NC by specialty
• Family Nurse Practitioner in North Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 14, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.