Healthcare Provider Details

I. General information

NPI: 1154035822
Provider Name (Legal Business Name): JAID LYONS PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: JAID GAMPP PA-C

II. Dates (important events)

Enumeration Date: 01/09/2023
Last Update Date: 06/26/2026
Certification Date: 06/26/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3705 OLENTANGY RIVER RD STE 100
COLUMBUS OH
43214-3467
US

IV. Provider business mailing address

PO BOX 7527
DUBLIN OH
43017-0727
US

V. Phone/Fax

Practice location:
  • Phone: 614-262-6772
  • Fax: 614-533-0162
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number50.007755RX
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number50.007755RX
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: