Basic Information
| Provider Information | |||||||||
| NPI: | 1467657999 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | LEWIS | ||||||||
| FirstName: | KRISTINA | ||||||||
| MiddleName: | HENDERSON | ||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | MD MPH SM | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 602658 | ||||||||
| Address2: | |||||||||
| City: | CHARLOTTE | ||||||||
| State: | NC | ||||||||
| PostalCode: | 282602658 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3367162011 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 4614 COUNTRY CLUB RD | ||||||||
| Address2: | |||||||||
| City: | WINSTON SALEM | ||||||||
| State: | NC | ||||||||
| PostalCode: | 271043520 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3367133234 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 06/15/2007 | ||||||||
| LastUpdateDate: | 09/16/2015 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | L-232046 | MA | N | Allopathic & Osteopathic Physicians | Internal Medicine | 207R00000X | 068449 | GA | N | Allopathic & Osteopathic Physicians | Internal Medicine | 207R00000X | 2015-01409 | NC | N | Allopathic & Osteopathic Physicians | Internal Medicine | 207RB0002X | 2015-01409 | NC | Y | Allopathic & Osteopathic Physicians | Internal Medicine | Bariatric Medicine |
No ID Information.