Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.

Kelly Jo Lewis, NURSEPRACTITIONER

Individual provider Primary Care Nurse Practitioner · NPI 1104389451

Kelly Jo Lewis, NURSEPRACTITIONER is a Nurse Practitioner in Kingman, Arizona. Qualified in 2023, 3 years ago. Licensed in Arizona.

Years since qualifying
3
Licensed in
AZ
In the registry since
2019

Practice location Address checks out

1510 N Stockton Hill Rd
Kingman, AZ 86401-5173
Phone: (928) 753-1177
Fax: (928) 753-1177
Show map & directions

Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Primary Care Nurse Practitioner (primary) Taxonomy 363LP2300X · Licence 307837 (AZ)

Record details

NPI number1104389451
Entity typeIndividual (Type 1)
GenderFemale
Credentials NURSEPRACTITIONER
Sole proprietorNo
NPI enumeratedApril 12, 2019
Last updated in NPPESMay 1, 2026
Certification dateMay 1, 2026

Medicare enrollment

From the CMS Doctors & Clinicians file — this clinician is enrolled in Medicare.

Medicare specialtyNURSE PRACTITIONER
Medical schoolOTHER
Graduated 2023 (3 years in practice)
Accepts Medicare assignment Not indicated

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