Individual
BLAKE ALLEN LEWIS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
500 WEST JEFFERSON ST, KIRKSVILLE, MO 63501
(866) 626-2878
Mailing address
1200 JAMISON ST, KIRKSVILLE, MO 63501-3946
Taxonomy
Speciality
Code
Description
License number
State
172A00000X
Driver
—
—
390200000X
Student in an Organized Health Care Education/Training Program
Primary
—
—
Other
Enumeration date
05/22/2023
Last updated
05/22/2023
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