Healthcare Provider Details

I. General information

NPI: 1235785981
Provider Name (Legal Business Name): KAYLA LYON
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/16/2019
Last Update Date: 08/16/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

455 K ST
CRESCENT CITY CA
95531-4107
US

IV. Provider business mailing address

455 K ST
CRESCENT CITY CA
95531-4107
US

V. Phone/Fax

Practice location:
  • Phone: 707-464-3191
  • Fax: 707-465-4272
Mailing address:
  • Phone: 707-464-3191
  • Fax: 707-465-4272

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: