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1205514957 NPI number — KELLIE BROOKE LYONS

NPI Number: 1205514957
Health Care Provider/Practitioner: KELLIE BROOKE LYONS

Information about “1205514957” NPI (KELLIE BROOKE LYONS) exists in 1205514957 in HTML format HTML  |  1205514957 in plain Text format TXT  |  1205514957 in PDF (Portable Document Format) PDF  |  1205514957 in an XML format XML  formats.

NPI Number : 1205514957 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1205514957",
    "EntityType": "Individual",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": "N",
    "IsOrgSubpart": null,
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": null,
    "LastName": "LYONS",
    "FirstName": "KELLIE",
    "MiddleName": "BROOKE",
    "NamePrefix": null,
    "NameSuffix": null,
    "Credential": null,
    "OtherOrgName": null,
    "OtherOrgNameTypeCode": null,
    "OtherLastName": "AGUIRRE",
    "OtherFirstName": "KELLIE",
    "OtherMiddleName": "BROOKE",
    "OtherNamePrefix": null,
    "OtherNameSuffix": null,
    "OtherCredential": null,
    "OtherLastNameTypeCode": "1",
    "FirstLineMailingAddress": "17197 FOXTROT WAY",
    "SecondLineMailingAddress": null,
    "MailingAddressCityName": "CONROE",
    "MailingAddressStateName": "TX",
    "MailingAddressPostalCode": "77302-5673",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": "281-467-7179",
    "MailingAddressFaxNumber": null,
    "FirstLinePracticeLocationAddress": "18220 STATE HIGHWAY 249",
    "SecondLinePracticeLocationAddress": null,
    "PracticeLocationAddressCityName": "HOUSTON",
    "PracticeLocationAddressStateName": "TX",
    "PracticeLocationAddressPostalCode": "77070-4347",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "281-737-9663",
    "PracticeLocationAddressFaxNumber": null,
    "EnumerationDate": "07/11/2023",
    "LastUpdateDate": "01/14/2025",
    "NPIDeactivationReasonCode": null,
    "NPIDeactivationReason": null,
    "NPIDeactivationDate": null,
    "NPIReactivationDate": null,
    "GenderCode": "F",
    "Gender": "Female",
    "AuthorizedOfficialLastName": null,
    "AuthorizedOfficialFirstName": null,
    "AuthorizedOfficialMiddleName": null,
    "AuthorizedOfficialTitle": null,
    "AuthorizedOfficialNamePrefix": null,
    "AuthorizedOfficialNameSuffix": null,
    "AuthorizedOfficialCredential": null,
    "AuthorizedOfficialTelephoneNumber": null,
    "Taxonomies": {
      "Taxonomy": {
        "TaxonomyCode": "363LA2200X",
        "TaxonomyName": "Adult Health Nurse Practitioner",
        "LicenseNumber": "1114843",
        "LicenseNumberStateCode": "TX",
        "PrimaryTaxonomySwitch": "Y"
      }
    },
    "HealthcareProviderTaxonomyGroups": null
  }
}
                
            

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