Individual
JACQUELYN AMERA LEWCHALERMWONG
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
1117 APPLE VALLEY RD, MADISON, TN 37115-2305
(310) 953-1919
Mailing address
PO BOX 645, INDEPENDENCE, VA 24348-0645
(310) 953-1919
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
MD-R-8813
IA
2084P0800X
Psychiatry Physician
2014-01801
NC
208D00000X
General Practice Physician
Primary
A118019
CA
Other
Enumeration date
05/20/2010
Last updated
07/17/2026
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