Provider Demographics
NPI:1447066808
Name:LEWIS, ANTONESHA CHERAE (APRN)
Entity type:Individual
Prefix:
First Name:ANTONESHA
Middle Name:CHERAE
Last Name:LEWIS
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:279 WINDSOR WAY
Mailing Address - Street 2:
Mailing Address - City:MIDWEST CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73110-3343
Mailing Address - Country:US
Mailing Address - Phone:405-361-3815
Mailing Address - Fax:
Practice Address - Street 1:1506 S AGNEW AVE
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73108-2432
Practice Address - Country:US
Practice Address - Phone:405-358-3131
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-12-10
Last Update Date:2024-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK220735363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily