Provider Demographics
NPI:1437173044
Name:LYELL, GENA E (NP)
Entity Type:Individual
Prefix:
First Name:GENA
Middle Name:E
Last Name:LYELL
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 455
Mailing Address - Street 2:
Mailing Address - City:CORYDON
Mailing Address - State:IN
Mailing Address - Zip Code:47112-0455
Mailing Address - Country:US
Mailing Address - Phone:823-738-4155
Mailing Address - Fax:812-738-6140
Practice Address - Street 1:313 FEDERAL DR NW
Practice Address - Street 2:SUITE 200
Practice Address - City:CORYDON
Practice Address - State:IN
Practice Address - Zip Code:47112-3070
Practice Address - Country:US
Practice Address - Phone:812-738-4155
Practice Address - Fax:812-738-6104
Is Sole Proprietor?:No
Enumeration Date:2006-07-27
Last Update Date:2020-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY4475P363LF0000X
IN71002361A363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN000000616162OtherANTHEM
IN351920057OtherTAX IDENTIFICATION NUMBER
IN000000616162OtherANTHEM