Provider Demographics
NPI:1134113095
Name:LYLES, RENEE J (NP)
Entity Type:Individual
Prefix:
First Name:RENEE
Middle Name:J
Last Name:LYLES
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 1:1001 14TH ST
Mailing Address - Street 2:
Mailing Address - City:MERIDIAN
Mailing Address - State:MS
Mailing Address - Zip Code:39301-4458
Mailing Address - Country:US
Mailing Address - Phone:601-482-9224
Mailing Address - Fax:601-482-9223
Practice Address - Street 1:1001 14TH ST
Practice Address - Street 2:
Practice Address - City:MERIDIAN
Practice Address - State:MS
Practice Address - Zip Code:39301-4458
Practice Address - Country:US
Practice Address - Phone:601-482-9224
Practice Address - Fax:601-482-9223
Is Sole Proprietor?:No
Enumeration Date:2005-09-07
Last Update Date:2018-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSR734185207LP2900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS00117020Medicaid
MS00117020Medicaid