Provider Demographics
NPI:1942877766
Name:LEWIS, LYNDON AUSTON (PA-C)
Entity type:Individual
Prefix:
First Name:LYNDON
Middle Name:AUSTON
Last Name:LEWIS
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17617 NE 26TH WAY
Mailing Address - Street 2:
Mailing Address - City:VANCOUVER
Mailing Address - State:WA
Mailing Address - Zip Code:98684-0748
Mailing Address - Country:US
Mailing Address - Phone:360-719-8889
Mailing Address - Fax:
Practice Address - Street 1:1152 DOUGLAS ST
Practice Address - Street 2:
Practice Address - City:LONGVIEW
Practice Address - State:WA
Practice Address - Zip Code:98632-2452
Practice Address - Country:US
Practice Address - Phone:360-940-0880
Practice Address - Fax:844-697-8702
Is Sole Proprietor?:No
Enumeration Date:2021-06-09
Last Update Date:2024-11-26
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
WAPA61083607363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant