Provider Demographics
NPI:1437787124
Name:LYONS, KAI BADER (CPM, LM)
Entity Type:Individual
Prefix:
First Name:KAI
Middle Name:BADER
Last Name:LYONS
Suffix:
Gender:F
Credentials:CPM, LM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5 GILDERSLEEVE WOOD
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTESVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:22903-3207
Mailing Address - Country:US
Mailing Address - Phone:434-981-3678
Mailing Address - Fax:
Practice Address - Street 1:4492 THREE NOTCH D RD
Practice Address - Street 2:
Practice Address - City:CHARLOTTESVILLE
Practice Address - State:VA
Practice Address - Zip Code:22901-6378
Practice Address - Country:US
Practice Address - Phone:434-981-3678
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-03-30
Last Update Date:2021-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0129-000163176B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes176B00000XOther Service ProvidersMidwifeGroup - Single Specialty