Healthcare Provider Details

I. General information

NPI: 1518593458
Provider Name (Legal Business Name): KATHERINE LYON FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/22/2020
Last Update Date: 05/12/2026
Certification Date: 05/12/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

101 DATES DR
ITHACA NY
14850-1342
US

IV. Provider business mailing address

15 EDWINA ST
DUNDEE NY
14837-1140
US

V. Phone/Fax

Practice location:
  • Phone: 607-274-4011
  • Fax:
Mailing address:
  • Phone: 607-425-0336
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number352027
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: