Individual
AUDRA BLYE LEWIS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
NP
Contact information
Practice address
2714 UNION EXTD, SUITE 150, MEMPHIS, TN 38112-4431
(901) 725-0872
(901) 278-6934
Mailing address
100 TRACE CV, SENATOBIA, MS 38668-4180
(901) 240-0438
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
R881185
MS
Other
Enumeration date
09/30/2015
Last updated
07/25/2018
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