MEDICARE: SARA LYONS PA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363A00000X	Physician Assistant

General Provider Information

NPI Number	:	1023722949
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SARA LYONS PA

Provider Business Mailing Address
First Line	:	12914 LAGUNA VISTA DR
Second Line	:
City	:	SAN ANTONIO
State	:	TX
Zip	:	78216-7711
Country	:	US
Telephone Number	:	701-228-4904
Fax Number	:

Provider Business Practice Location Address
First Line	:	2122 BABCOCK RD STE 101
Second Line	:
City	:	SAN ANTONIO
State	:	TX
Zip	:	78229-4411
Country	:	US
Telephone Number	:	701-228-4904
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/06/2023
Last Update Date	:	01/08/2023

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Directions to “ SARA LYONS PA” Practice Location

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