Provider Demographics
NPI:1033119078
Name:LYONS, ARNEDA FAYE (FNP)
Entity Type:Individual
Prefix:
First Name:ARNEDA
Middle Name:FAYE
Last Name:LYONS
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4751 BARTON DR
Mailing Address - Street 2:
Mailing Address - City:DUBLIN
Mailing Address - State:VA
Mailing Address - Zip Code:24084-6065
Mailing Address - Country:US
Mailing Address - Phone:540-239-5375
Mailing Address - Fax:
Practice Address - Street 1:5261 CARROLLTON PIKE STE F
Practice Address - Street 2:
Practice Address - City:WOODLAWN
Practice Address - State:VA
Practice Address - Zip Code:24381-3034
Practice Address - Country:US
Practice Address - Phone:276-601-6197
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-07-29
Last Update Date:2019-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0024164161363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA1033119078Medicaid
VA5901928Medicaid
VA060001085Medicare ID - Type Unspecified
VA014088C87Medicare PIN
VA018057C18Medicare PIN
VA019673D28Medicare PIN
VA5901928Medicaid
VA014087C63Medicare PIN