Provider Demographics
NPI:1871211656
Name:LEWIS, KANDON LEE (MS, RD)
Entity type:Individual
Prefix:MRS
First Name:KANDON
Middle Name:LEE
Last Name:LEWIS
Suffix:
Gender:F
Credentials:MS, RD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3404 COONEY DR STE 108
Mailing Address - Street 2:
Mailing Address - City:HELENA
Mailing Address - State:MT
Mailing Address - Zip Code:59602-0215
Mailing Address - Country:US
Mailing Address - Phone:406-600-2259
Mailing Address - Fax:
Practice Address - Street 1:3404 COONEY DR STE 108
Practice Address - Street 2:
Practice Address - City:HELENA
Practice Address - State:MT
Practice Address - Zip Code:59602-0215
Practice Address - Country:US
Practice Address - Phone:406-952-3772
Practice Address - Fax:406-315-6686
Is Sole Proprietor?:No
Enumeration Date:2022-08-18
Last Update Date:2022-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT86253288133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered