Healthcare Provider Details

I. General information

NPI: 1700563855
Provider Name (Legal Business Name): KEVIN ROBERT LYFORD PA-C
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/30/2023
Last Update Date: 12/18/2024
Certification Date: 12/18/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

321 MULBERRY ST SW
LENOIR NC
28645-5720
US

IV. Provider business mailing address

5512 SUTTLEMYRE LN
HICKORY NC
28601-9426
US

V. Phone/Fax

Practice location:
  • Phone: 828-757-5504
  • Fax: 828-757-5225
Mailing address:
  • Phone: 828-461-2440
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number0010-13319
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: