Healthcare Provider Details

I. General information

NPI: 1861667966
Provider Name (Legal Business Name): MR. THOMAS N LYON
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/29/2008
Last Update Date: 04/30/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3091 HIGHWAY 31 S
BEEBE AR
72012-9347
US

IV. Provider business mailing address

3091 HIGHWAY 31 S
BEEBE AR
72012-9347
US

V. Phone/Fax

Practice location:
  • Phone: 501-882-5551
  • Fax:
Mailing address:
  • Phone: 501-882-5551
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code374U00000X
TaxonomyHome Health Aide
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: