Healthcare Provider Details

I. General information

NPI: 1891332615
Provider Name (Legal Business Name): NAKERA MICHELLE LYONS RBT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/01/2019
Last Update Date: 02/07/2022
Certification Date: 02/07/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11 HOPE RD STE 215
STAFFORD VA
22554-7287
US

IV. Provider business mailing address

11200 CHERRY HILL RD APT 201
BELTSVILLE MD
20705-3806
US

V. Phone/Fax

Practice location:
  • Phone: 540-225-1020
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code376J00000X
TaxonomyHomemaker
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number StateNULL
# 3
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License NumberRBT-20-119642
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: