Healthcare Provider Details

I. General information

NPI: 1134113095
Provider Name (Legal Business Name): RENEE J LYLES NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/07/2005
Last Update Date: 03/21/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1001 14TH ST
MERIDIAN MS
39301-4458
US

IV. Provider business mailing address

1001 14TH ST
MERIDIAN MS
39301-4458
US

V. Phone/Fax

Practice location:
  • Phone: 601-482-9224
  • Fax: 601-482-9223
Mailing address:
  • Phone: 601-482-9224
  • Fax: 601-482-9223

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207LP2900X
TaxonomyPain Medicine (Anesthesiology) Physician
License NumberR734185
License Number StateMS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: