Provider Demographics
NPI:1225635378
Name:LYONS, DAVID WOOD (NP)
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:WOOD
Last Name:LYONS
Suffix:
Gender:M
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:125 N PARKWOOD LN
Mailing Address - Street 2:
Mailing Address - City:PAYSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85541-4353
Mailing Address - Country:US
Mailing Address - Phone:928-970-1117
Mailing Address - Fax:
Practice Address - Street 1:807 W LONGHORN RD
Practice Address - Street 2:
Practice Address - City:PAYSON
Practice Address - State:AZ
Practice Address - Zip Code:85541-4263
Practice Address - Country:US
Practice Address - Phone:928-474-1120
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-10-01
Last Update Date:2022-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ175448163W00000X
AZ255413363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No163W00000XNursing Service ProvidersRegistered Nurse