Individual
KEVIN A LEWELLEN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
CRNA
Contact information
Practice address
CORNER OF ROUTE N12 AND N7, FORT DEFIANCE, AZ 86504
(928) 729-8000
Mailing address
PO BOX 649, FORT DEFIANCE, AZ 86504-0649
(928) 729-8000
Taxonomy
Speciality
Code
Description
License number
State
367500000X
Certified Registered Nurse Anesthetist
Primary
APN11125
TN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
3626474
—
TN
01
—
4024090
BLUE CROSS PROVIDER NUMBE
TN
01
—
430066708
RR MEDICARE
TN
Enumeration date
07/19/2006
Last updated
05/22/2019
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