Provider Demographics
NPI:1437914991
Name:LYMAN, KERA JENELLE (CPM, LDEM)
Entity Type:Individual
Prefix:
First Name:KERA
Middle Name:JENELLE
Last Name:LYMAN
Suffix:
Gender:F
Credentials:CPM, LDEM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3701 SILVERSTONE DR
Mailing Address - Street 2:
Mailing Address - City:IDAHO FALLS
Mailing Address - State:ID
Mailing Address - Zip Code:83401-5195
Mailing Address - Country:US
Mailing Address - Phone:801-857-5182
Mailing Address - Fax:
Practice Address - Street 1:3701 SILVERSTONE DR
Practice Address - Street 2:
Practice Address - City:IDAHO FALLS
Practice Address - State:ID
Practice Address - Zip Code:83401-5195
Practice Address - Country:US
Practice Address - Phone:801-857-5182
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-02-14
Last Update Date:2024-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT13269852-3400176B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes176B00000XOther Service ProvidersMidwife