Healthcare Provider Details

I. General information

NPI: 1023213360
Provider Name (Legal Business Name): KATHRYN MICHELE LYONS MN, RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/18/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

433 PLAZA ST
BOGALUSA LA
70427-3729
US

IV. Provider business mailing address

1203 AVENUE L
BOGALUSA LA
70427-4129
US

V. Phone/Fax

Practice location:
  • Phone: 985-730-6773
  • Fax: 985-730-6777
Mailing address:
  • Phone: 985-732-9834
  • Fax: 985-730-6777

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WD0400X
TaxonomyDiabetes Educator Registered Nurse
License NumberRN 103923
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: