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NPI Code Detail

MEDICARE: JENNIFER GRAHAM LYERLY RN

MEDICARE:   JENNIFER GRAHAM LYERLY  RN
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1163WS0200XSchool Registered Nurse94573SC

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1134561350
Entity Type Code : Individual
Provider Name (Legal Business Name) : JENNIFER GRAHAM LYERLY RN
Provider Business Mailing Address
First Line : 652 N MATTHEWS RD
Second Line :
City : LAKE CITY
State : SC
Zip : 29560-7008
Country : US
Telephone Number : 843-374-5119
Fax Number : 843-374-2713
Provider Business Practice Location Address
First Line : 652 N MATTHEWS RD
Second Line :
City : LAKE CITY
State : SC
Zip : 29560-7008
Country : US
Telephone Number : 843-374-5119
Fax Number : 843-374-2713
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/30/2013
Last Update Date : 07/30/2013

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Directions to “ JENNIFER GRAHAM LYERLY RN” Practice Location

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