Provider Demographics
NPI:1609006428
Name:LEWIS, KAYCI DAE (DO)
Entity type:Individual
Prefix:DR
First Name:KAYCI
Middle Name:DAE
Last Name:LEWIS
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:4140 W MEMORIAL RD
Mailing Address - Street 2:SUITE 215
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73120-8361
Mailing Address - Country:US
Mailing Address - Phone:405-242-4030
Mailing Address - Fax:405-242-4031
Practice Address - Street 1:4140 W MEMORIAL RD
Practice Address - Street 2:SUITE 215
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73120-8361
Practice Address - Country:US
Practice Address - Phone:405-242-4030
Practice Address - Fax:405-242-4031
Is Sole Proprietor?:No
Enumeration Date:2009-07-15
Last Update Date:2015-10-27
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
OK4787207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK200254870AMedicaid