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KELLY JO LEWIS NURSE PRACTITIONER
NPI 1104389451
Nurse Practitioner - Primary Care in Kingman, AZ

Active since April 12, 2019PECOS Enrolled
1510 N STOCKTON HILL RD, KINGMAN, AZ 86401(928) 753-1177(928) 753-1177 Get Directions Write a Review

NPPES record last updated: May 1, 2026. Verified against the NPPES registry weekly; last sync: August 02, 2026.

Record update history: May 1, 2026, Sep 3, 2024, Apr 12, 2019 (3 updates tracked since 2019).

About Kelly Jo Lewis Nurse Practitioner NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

KELLY JO LEWIS NURSE PRACTITIONER (NPI 1104389451) is an individual primary care provider in Kingman, Arizona, licensed in Arizona (307837) and active in the NPI registry since April 2019. She is enrolled in Medicare PECOS and is a graduate of Other (2023).

NPPES Registry Identity

NPI1104389451
Entity TypeIndividualFemale
Primary Taxonomy363LP2300X
Provider Legal NameKELLY JO LEWISCredential: NURSE PRACTITIONER
Location Address1510 N STOCKTON HILL RDKingman, AZ 86401-5173
Mailing AddressPo Box 1231Tucson, AZ 85702-1231 · (520) 670-3909 · Fax (520) 309-2560
Phone(928) 753-1177
Fax(928) 753-1177
Sole ProprietorNo
Medical School CMSOtherGraduated 2023
Enumeration DateApril 12, 2019
Last NPPES UpdateMay 1, 20263 updates tracked since enumeration
NPPES CertifiedMay 1, 2026
✔ NPI 1104389451 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyNurse Practitioner · Primary CarePhysician Assistants & Advanced Practice Nursing Providers
Taxonomy Code363LP2300X
License✔ Licensed in AZ · 307837
1510 N STOCKTON HILL RD, Kingman, AZ 86401
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Accepted Insurance

The full list of accepted plans is on the Insurance tab. Issuers include Blue Cross Blue Shield of Arizona, UnitedHealthcare.Insurance ›

Medicare Participation & PECOS CMS

Medicare enrollment, assignment, and ordering and referring status from the CMS PECOS system.

Medicare Enrollment Status

✔

Enrolled in Medicare (PECOS)

Kelly Jo Lewis Nurse Practitioner is registered in the CMS Provider Enrollment, Chain and Ownership System (PECOS).

PECOS PAC ID7214478437
PECOS Enrollment IDI20240916001237
Eligible to Order & Refer✔ Part B Labs & Imaging✔ Durable Medical Equipment✔ Home Health Agency✔ Power Mobility DevicesPer the CMS Ordering and Referring file. Eligibility means Medicare pays claims that this provider orders or refers for these categories.

Physician Visit Costs CMS claims · ZIP area

Typical Medicare office-visit costs in the 86401 ZIP code area, from fee-for-service claims. These are area statistics, not this provider’s prices; actual charges vary by service and coverage.

New Patient
$85.89 typical visit price
range $55.44 – $168.60
Typical copayment $21.47 (range $13.86 – $42.15)
Most-billed visit code 99203
Established Patient
$98.00 typical visit price
range $17.72 – $137.41
Typical copayment $24.50 (range $4.43 – $34.35)
Most-billed visit code 99214
Amounts reflect what Medicare beneficiaries in this ZIP area are typically charged for office visits. Patients with other coverage should check their individual plans.

Other Providers at the Same Location NPPES 20

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

NORTH COUNTRY HEALTHCARE, INC.
Pharmacy (Clinic Pharmacy)
1510 N STOCKTON HILL RD
KINGMAN, AZ 86401
Mohave County (928) 718-4510
AMANDA THOMS CNP
Nurse Practitioner (Family)
1510 N STOCKTON HILL RD
KINGMAN, AZ 86401
Mohave County (928) 753-1177
DR. TIFFANY E RUSSELL MD
Internal Medicine
1510 N STOCKTON HILL RD
KINGMAN, AZ 86401
Mohave County (928) 753-1177
EL RIO SANTA CRUZ NEIGHBORHOOD HEALTH CENTER INC
Clinic/Center (Federally Qualified Health Center (FQHC))
1510 N STOCKTON HILL RD
KINGMAN, AZ 86401
Mohave County (520) 670-3909
ELK RIDGE KINGMAN PHARMACY
Pharmacy (Clinic Pharmacy)
1510 N STOCKTON HILL RD
KINGMAN, AZ 86401
Mohave County (520) 670-3909
MRS. KATHLEEN SUZANNE FLOREA NP
Nurse Practitioner (Family)
1510 N STOCKTON HILL RD
KINGMAN, AZ 86401
Mohave County (928) 753-1177
MR. SEAN L'HUILLIER SR. FNP-C
Nurse Practitioner (Family)
1510 N STOCKTON HILL RD
KINGMAN, AZ 86401
Mohave County (928) 753-1177
NORTH COUNTRY HEALTHCARE, INC.
Clinic/Center (Multi-Specialty)
1510 N STOCKTON HILL RD
KINGMAN, AZ 86401
Mohave County (928) 753-1177

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Kelly Lewis's NPI number?

The NPI number for Kelly Lewis is 1104389451. It was assigned to this individual provider in the NPPES registry on April 12, 2019.

Where is Kelly Lewis located?

Kelly Lewis practices at 1510 N Stockton Hill Rd, Kingman, AZ 86401. The listed phone number is (928) 753-1177.

What is Kelly Lewis's specialty?

The primary specialty registered for this NPI is Nurse Practitioner, specializing in Primary Care, with taxonomy code 363LP2300X.

Is Kelly Lewis enrolled in Medicare?

Yes. Kelly Lewis is registered in the Medicare PECOS enrollment system.

What insurance does Kelly Lewis accept?

Health plans from Blue Cross Blue Shield of Arizona and UnitedHealthcare list Kelly Lewis as in-network in at least one marketplace plan. Coverage varies by plan and year; verify with the insurer or the provider before a visit.

When was this NPI record last updated?

The NPPES record for Kelly Lewis was last updated on May 1, 2026. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 3 months ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.