Provider Demographics
NPI:1144850801
Name:LYON, ALEXANDRIA NICOLE (PA)
Entity type:Individual
Prefix:
First Name:ALEXANDRIA
Middle Name:NICOLE
Last Name:LYON
Suffix:
Gender:F
Credentials:PA
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 431
Mailing Address - Street 2:
Mailing Address - City:RAPIDS CITY
Mailing Address - State:IL
Mailing Address - Zip Code:61278-0431
Mailing Address - Country:US
Mailing Address - Phone:309-373-0334
Mailing Address - Fax:
Practice Address - Street 1:3200 W KIMBERLY RD
Practice Address - Street 2:
Practice Address - City:DAVENPORT
Practice Address - State:IA
Practice Address - Zip Code:52806-3059
Practice Address - Country:US
Practice Address - Phone:563-421-0100
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-01-22
Last Update Date:2025-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
103TP0016X
IA099852363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No103TP0016XBehavioral Health & Social Service ProvidersPsychologistPrescribing (Medical)