Healthcare Provider Details

I. General information

NPI: 1467389601
Provider Name (Legal Business Name): HAILEY JO-ANN LYLE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/04/2026
Last Update Date: 05/05/2026
Certification Date: 05/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2550 EVANS TRADE CENTER DRIVE
EVANS GA
30809
US

IV. Provider business mailing address

PO BOX 360595, PITTSBURGH PA 15251
PITTSBURGH PA
15251-0001
US

V. Phone/Fax

Practice location:
  • Phone: 718-215-5311
  • Fax: 718-865-5311
Mailing address:
  • Phone: 718-215-5311
  • Fax: 718-865-5311

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: