Healthcare Provider Details

I. General information

NPI: 1982001905
Provider Name (Legal Business Name): ANDREW HALE LYONS FNP-BC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/20/2014
Last Update Date: 01/15/2020
Certification Date: 01/15/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4475 S. I-19 FRONTAGE RD, SUITE 255
GREEN VALLEY AZ
85614-1254
US

IV. Provider business mailing address

4455 S I-19 FRONTAGE RD
GREEN VALLEY AZ
85614-1254
US

V. Phone/Fax

Practice location:
  • Phone: 520-393-4863
  • Fax: 833-485-4196
Mailing address:
  • Phone: 520-393-4486
  • Fax: 833-485-4196

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAP7433
License Number StateAZ
# 2
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN166025
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: