Individual
LAJARVIS ANTWON LEWIS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
FNP
Contact information
Practice address
840 N OAK AVE, RULEVILLE, MS 38771-3227
(662) 756-4024
Mailing address
PO BOX 4187, CLEVELAND, MS 38732-5287
(662) 719-9414
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
903985
MS
Other
Enumeration date
06/26/2020
Last updated
06/26/2020
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