Provider Demographics
NPI:1053626622
Name:LYON, JERRY MILTON (FNP-BC)
Entity Type:Individual
Prefix:
First Name:JERRY
Middle Name:MILTON
Last Name:LYON
Suffix:
Gender:M
Credentials:FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2505 NOEL AVE
Mailing Address - Street 2:
Mailing Address - City:MIDLAND
Mailing Address - State:TX
Mailing Address - Zip Code:79705-3336
Mailing Address - Country:US
Mailing Address - Phone:432-638-7311
Mailing Address - Fax:
Practice Address - Street 1:5000 BRIARWOOD AVE STE 203
Practice Address - Street 2:
Practice Address - City:MIDLAND
Practice Address - State:TX
Practice Address - Zip Code:79707
Practice Address - Country:US
Practice Address - Phone:432-687-6870
Practice Address - Fax:432-687-5558
Is Sole Proprietor?:No
Enumeration Date:2010-08-08
Last Update Date:2019-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAP119132363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily