Healthcare Provider Details

I. General information

NPI: 1043673288
Provider Name (Legal Business Name): KATHERINE A LYONS MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/04/2016
Last Update Date: 05/30/2024
Certification Date: 05/30/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8040 PRINCETON GLENDALE RD
WEST CHESTER OH
45069-5802
US

IV. Provider business mailing address

8040 PRINCETON GLENDALE RD
WEST CHESTER OH
45069-5802
US

V. Phone/Fax

Practice location:
  • Phone: 513-862-4957
  • Fax: 513-862-4952
Mailing address:
  • Phone: 513-862-4957
  • Fax: 513-862-4952

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207RB0002X
TaxonomyObesity Medicine (Internal Medicine) Physician
License Number35.136045
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: