# JUSTIN J LEWIS

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- **Entity:** Individual
- **Status:** Active
- **Sole proprietor:** No

## Provider details

- **NPI number:** 1538696356
- **Gender:** Man
- **Credential:** PA-C

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 224Z00000X | Occupational Therapy Assistant | 136934 | KY | — |
| 363A00000X | Physician Assistant | PA2237 | KY | Yes |
| 363A00000X | Physician Assistant | TC604 | KY | — |

## Other

- **Enumeration date:** 05/11/2017
- **Last updated:** 04/25/2025

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 01 | — | 000001106789 | ANTHEM BLUE CROSS AND BLUE SHIELD OF KY | KY |