Healthcare Provider Details

I. General information

NPI: 1275485799
Provider Name (Legal Business Name): BROOKE ALEXIS LYON
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/10/2026
Last Update Date: 05/20/2026
Certification Date: 05/20/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1085 JOE SKINNER RD
BELPRE OH
45714-9488
US

IV. Provider business mailing address

1085 JOE SKINNER RD
BELPRE OH
45714-9488
US

V. Phone/Fax

Practice location:
  • Phone: 740-538-5405
  • Fax:
Mailing address:
  • Phone: 740-538-5405
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberAPRN.CNP.0042217
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberR.N.533366
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: