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
330490
AZ
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
06/22/2026
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