Healthcare Provider Details

I. General information

NPI: 1043524218
Provider Name (Legal Business Name): TERESA ANN BROWN LYONS NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/30/2010
Last Update Date: 05/03/2023
Certification Date: 05/03/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

815 2ND AVE STE 122
FAIRBANKS AK
99701-4469
US

IV. Provider business mailing address

PO BOX 72376
FAIRBANKS AK
99707-2376
US

V. Phone/Fax

Practice location:
  • Phone: 907-374-0852
  • Fax: 907-374-0854
Mailing address:
  • Phone: 907-374-0852
  • Fax: 907-374-0854

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WP0809X
TaxonomyAdult Psychiatric/Mental Health Registered Nurse
License Number9082
License Number StateAK
# 2
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number1249
License Number StateAK
# 3
Primary TaxonomyN
Taxonomy Code163WP0807X
TaxonomyChild & Adolescent Psychiatric/Mental Health Registered Nurse
License Number765474
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: