Healthcare Provider Details

I. General information

NPI: 1093707630
Provider Name (Legal Business Name): REBECCA LYONS CRNA
Entity Type: Individual
Gender: Female
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 08/19/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1140 LEXINGTON RD
GEORGETOWN KY
40324-9330
US

IV. Provider business mailing address

3320 TATES CREEK RD SUITE 204
LEXINGTON KY
40502-3400
US

V. Phone/Fax

Practice location:
  • Phone: 502-868-1100
  • Fax:
Mailing address:
  • Phone: 859-268-1030
  • Fax: 859-269-4120

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number4087A
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: