Healthcare Provider Details

I. General information

NPI: 1437173044
Provider Name (Legal Business Name): GENA E. LYELL NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/27/2006
Last Update Date: 12/08/2020
Certification Date: 12/08/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

313 FEDERAL DR NW SUITE 200
CORYDON IN
47112-3070
US

IV. Provider business mailing address

PO BOX 455
CORYDON IN
47112-0455
US

V. Phone/Fax

Practice location:
  • Phone: 812-738-4155
  • Fax: 812-738-6104
Mailing address:
  • Phone: 823-738-4155
  • Fax: 812-738-6140

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number4475P
License Number StateKY
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number71002361A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: