Individual provider Active NPI

Mackenzie Lewis, APRN

  • Psychiatric/Mental Health Nurse Practitioner
  • Bowling Green, KY
National Provider Identifier
1992301105
Registry record updated Dec 11, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Psychiatric/Mental Health Nurse PractitionerTaxonomy code 363LP0808X
License
3015468 Issued in KY
Practice address
2459 Mount Victor LN
Bowling Green, KY 42103-9061
Phone
(270) 935-5234
Fax
(270) 935-5173
NPI assigned
Dec 11, 2020
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Dec 11, 2020

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Psychiatric/Mental Health Nurse Practitioner 363LP0808X 3015468 KY Primary

Addresses

Primary practice location

2459 Mount Victor LN
Bowling Green, KY 42103-9061

Mailing address

2459 Mount Victor LN
Bowling Green, KY 42103-9061
Phone (270) 935-5234

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in KY
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

Enrollment IDStateProvider typePAC IDDetails
I20210129000878 KY Practitioner - Nurse Practitioner 2668886854 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2020
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Onyx Regent Health and Wellness, LLCGroup PAC ID 9830514033, 5 clinicians

Practice addresses (Care Compare)

351 Pascoe Blvd
Suite 100
Bowling Green, KY 42104-6302
Phone (270) 935-5234

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
3015468KYMDPsychiatric/Mental Health Nurse Practitioner

Organizations & group practices 1

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.

NPI Registry JSON

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

{
    "created_epoch": "1607644800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1607644800000",
    "number": "1992301105",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2459 MOUNT VICTOR LN",
            "city": "BOWLING GREEN",
            "state": "KY",
            "postal_code": "421039061",
            "telephone_number": "270-935-5234",
            "fax_number": "270-935-5173"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2459 MOUNT VICTOR LN",
            "city": "BOWLING GREEN",
            "state": "KY",
            "postal_code": "421039061",
            "telephone_number": "270-935-5234",
            "fax_number": "270-935-5173"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "LEWIS",
        "first_name": "MACKENZIE",
        "credential": "APRN",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2020-12-11",
        "last_updated": "2020-12-11",
        "certification_date": "2020-12-11",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LP0808X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Psychiatric/Mental Health",
            "state": "KY",
            "license": "3015468",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Bowling Green, KY

Sources for this page

Verify at the official NPI Registry.