Provider Demographics
NPI:1043272990
Name:LYLE, CARLENE WILLIAMS (MD)
Entity Type:Individual
Prefix:
First Name:CARLENE
Middle Name:WILLIAMS
Last Name:LYLE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:2601 KAVANAUGH BLVD
Mailing Address - Street 2:SUITE 5
Mailing Address - City:LITTLE ROCK
Mailing Address - State:AR
Mailing Address - Zip Code:72205-3990
Mailing Address - Country:US
Mailing Address - Phone:501-663-8990
Mailing Address - Fax:501-663-8997
Practice Address - Street 1:2601 KAVANAUGH BLVD
Practice Address - Street 2:SUITE 5
Practice Address - City:LITTLE ROCK
Practice Address - State:AR
Practice Address - Zip Code:72205-3990
Practice Address - Country:US
Practice Address - Phone:501-663-8990
Practice Address - Fax:501-663-8997
Is Sole Proprietor?:No
Enumeration Date:2006-04-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARC73502084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR51737Medicare ID - Type Unspecified
ARC68289Medicare UPIN