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General NPI Number Information
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NPI Number | 1669528741
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Entity Type | Individual
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Provider Name | KENNETH D. LYONS PA-C
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Gender | Male
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Dates
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Enumeration Date | 01/25/2007
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Last Update Date | 10/02/2020
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Provider Practice Location Address
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Address Line | 799 HIGHLAND AVE
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City | WINSTON SALEM
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State | NC
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Zip | 27101-4206
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Country | US
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Telephone | 336-703-3316
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Fax |
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Provider Business Mailing Address
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Address Line | 1140 ANDERSON RD
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City | SILOAM
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State | NC
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Zip | 27047-9177
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Country | US
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Telephone | 336-374-2806
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363AM0700X
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Taxonomy Name | Medical Physician Assistant
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License Number | 101183
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License Number State | NC
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Taxonomy #2
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | 101183
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License Number State | NC
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