Healthcare Provider Details

I. General information

NPI: 1023303922
Provider Name (Legal Business Name): STARLA N. LYLES MCKELVY DO
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: STARLA NICOLE LYLES DO

II. Dates (important events)

Enumeration Date: 06/20/2011
Last Update Date: 02/09/2021
Certification Date: 02/09/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12625 HESPERIA RD
VICTORVILLE CA
92395-7720
US

IV. Provider business mailing address

12625 HESPERIA RD
VICTORVILLE CA
92395-7720
US

V. Phone/Fax

Practice location:
  • Phone: 760-995-8300
  • Fax: 760-995-8300
Mailing address:
  • Phone: 209-381-6800
  • Fax: 760-995-8300

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number0102203199
License Number StateVA
# 2
Primary TaxonomyN
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number20A14833
License Number StateCA
# 3
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number20A14833
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: