Individual
MRS. ROSELINE KAGONYA LEWIS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
NP
Contact information
Practice address
701 S HOLLY AVE, COLLINS, MS 39428-3894
(601) 698-0238
Mailing address
701 S HOLLY AVE, COLLINS, MS 39428-3894
Taxonomy
Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
R784836
MS
363L00000X
Nurse Practitioner
Primary
R784836
MS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00124929
—
MS
01
—
512G700003
MS MEDICARE - GROUP
MS
Enumeration date
10/27/2006
Last updated
09/23/2024
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