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NPI Code Detail

MEDICARE: CARLY LYLE

MEDICARE: CARLY LYLE
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
1104100000XSocial Worker224359AK

General Provider Information

NPI Number : 1225813330
Entity Type Code : Individual
Provider Name (Legal Business Name) : CARLY LYLE
Provider Business Mailing Address
First Line : 15 FAREWELL AVE UNIT 316
Second Line :
City : FAIRBANKS
State : AK
Zip : 99701-3584
Country : US
Telephone Number : 907-347-3357
Fax Number :
Provider Business Practice Location Address
First Line : 1825 MARIKA RD
Second Line :
City : FAIRBANKS
State : AK
Zip : 99709-5521
Country : US
Telephone Number : 907-347-3357
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/28/2023
Last Update Date : 06/06/2026

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Directions to “ CARLY LYLE ” Practice Location

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