Healthcare Provider Details

I. General information

NPI: 1508720780
Provider Name (Legal Business Name): KELLY LYONS MS, CPT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/12/2025
Last Update Date: 12/12/2025
Certification Date: 12/12/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

971 US HIGHWAY 202 N STE N
BRANCHBURG NJ
08876-3757
US

IV. Provider business mailing address

971 US HIGHWAY 202 N STE N
BRANCHBURG NJ
08876-3757
US

V. Phone/Fax

Practice location:
  • Phone: 601-308-1201
  • Fax:
Mailing address:
  • Phone: 601-308-1201
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174H00000X
TaxonomyHealth Educator
License Number
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: