MEDICARE: BESSTINA LYLES PHYSICIAN ASSISTANT

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	973	AL
2	363A00000X	Physician Assistant	6209	GA

General Provider Information

NPI Number	:	1164705513
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BESSTINA LYLES PHYSICIAN ASSISTANT

Provider Business Mailing Address
First Line	:	2227 DRAKE AVE SW STE 26
Second Line	:
City	:	HUNTSVILLE
State	:	AL
Zip	:	35805-5146
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	2227 DRAKE AVE SW STE 26
Second Line	:
City	:	HUNTSVILLE
State	:	AL
Zip	:	35805-5146
Country	:	US
Telephone Number	:	256-801-9296
Fax Number	:

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

Provider Enumeration Date	:	09/22/2011
Last Update Date	:	02/11/2015

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Directions to “ BESSTINA LYLES PHYSICIAN ASSISTANT” Practice Location

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