Kelly A Lewis, PT

Primary specialty

Licensed Psychiatric TechnicianTaxonomy code 167G00000X

License

PT36628 Issued in CA

Practice address

2180 Johnson Ave
San Luis Obispo, CA 93401-4513

Phone

(805) 781-4394

NPI assigned

Sep 27, 2012

Last updated

May 29, 2025By the provider in NPPES

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

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

{
    "created_epoch": "1348704000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1748476800000",
    "number": "1497006662",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2178 JOHNSON AVE",
            "city": "SAN LUIS OBISPO",
            "state": "CA",
            "postal_code": "934014535",
            "telephone_number": "805-781-4868"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2180 JOHNSON AVE",
            "city": "SAN LUIS OBISPO",
            "state": "CA",
            "postal_code": "934014513",
            "telephone_number": "805-781-4394"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "LEWIS",
        "first_name": "KELLY",
        "middle_name": "A",
        "name_prefix": "Mr.",
        "credential": "PT",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2012-09-27",
        "last_updated": "2025-05-29",
        "certification_date": "2025-05-29",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "167G00000X",
            "taxonomy_group": "",
            "desc": "Licensed Psychiatric Technician",
            "state": "CA",
            "license": "PT36628",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• David Sanford Levy, PA-C
• Heidi Michele Lewin-Miller, LMFT, RD
• Cheryl Marie Lewis, N.P.
• Daniel Richard Lewis, M.D.
• Jaycee Delanie Lewis
• Maggie Lewis
• Martha Treleven Lewis, MFTI
• Nicholas Alan Leyden, BS, MS, CSCS
• Feng Ling Li de Wang, ACUPUNCTURIST
• Kirsten Liana

• Licensed Psychiatric Technician in San Luis Obispo, CA
• Providers in San Luis Obispo, CA by specialty
• Licensed Psychiatric Technician in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 29, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.