Provider Demographics
NPI:1043524218
Name:LYONS, TERESA ANN BROWN (NP)
Entity Type:Individual
Prefix:MS
First Name:TERESA
Middle Name:ANN BROWN
Last Name:LYONS
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 72376
Mailing Address - Street 2:
Mailing Address - City:FAIRBANKS
Mailing Address - State:AK
Mailing Address - Zip Code:99707-2376
Mailing Address - Country:US
Mailing Address - Phone:907-374-0852
Mailing Address - Fax:907-374-0854
Practice Address - Street 1:815 2ND AVE STE 122
Practice Address - Street 2:
Practice Address - City:FAIRBANKS
Practice Address - State:AK
Practice Address - Zip Code:99701-4469
Practice Address - Country:US
Practice Address - Phone:907-374-0852
Practice Address - Fax:907-374-0854
Is Sole Proprietor?:No
Enumeration Date:2010-07-30
Last Update Date:2023-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK9082163WP0809X, 163WP0809X
AK1249363LP0808X
CA765474163WP0807X, 163WP0809X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No163WP0809XNursing Service ProvidersRegistered NursePsychiatric/Mental Health, Adult
No163WP0807XNursing Service ProvidersRegistered NursePsychiatric/Mental Health, Child & Adolescent
Provider Identifiers
StateIdentifier IDID TypeIssuer
AK1575076Medicaid