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General NPI Number Information
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NPI Number | 1679976179
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Entity Type | Individual
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Provider Name | RACHEL DIANE LYLE APRN
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Gender | Female
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Dates
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Enumeration Date | 09/29/2014
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Last Update Date | 07/09/2024
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Provider Practice Location Address
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Address Line | 2108 S 54TH ST STE 1
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City | ROGERS
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State | AR
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Zip | 72758-8125
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Country | US
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Telephone | 479-396-5200
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Fax |
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Provider Business Mailing Address
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Address Line | 6912 S QUENTIN ST STE 50
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City | CENTENNIAL
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State | CO
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Zip | 80112-4531
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Country | US
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Telephone | 501-686-8711
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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 | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | A004190
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License Number State | AR
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