Individual
JERRY LEWIS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
1606R W CHERRY ST, CLARKSVILLE, AR 72830-2506
(479) 979-4909
Mailing address
1606R W CHERRY ST, CLARKSVILLE, AR 72830-2506
(479) 979-4909
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
—
—
3747A0650X
Attendant Care Provider
Primary
—
—
Other
Enumeration date
09/22/2019
Last updated
11/05/2019
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