Healthcare Provider Details

I. General information

NPI: 1609446962
Provider Name (Legal Business Name): REBEKAH ANNE LYLE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/29/2021
Last Update Date: 06/03/2026
Certification Date: 06/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3010 HIGHWAY 22 E STE A
BRANCH AR
72928-9648
US

IV. Provider business mailing address

631 W 8TH ST
BOONEVILLE AR
72927-3146
US

V. Phone/Fax

Practice location:
  • Phone: 479-965-2191
  • Fax:
Mailing address:
  • Phone: 479-275-9477
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number201568
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: