Provider Demographics
NPI:1467935718
Name:STARKS, LYLAH DAWN (CRNP)
Entity Type:Individual
Prefix:
First Name:LYLAH
Middle Name:DAWN
Last Name:STARKS
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:
Other - First Name:LYLAH
Other - Middle Name:DAWN
Other - Last Name:KIEFFER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:7 DOCK HILL RD
Mailing Address - Street 2:
Mailing Address - City:MIDDLEBURG
Mailing Address - State:PA
Mailing Address - Zip Code:17842-8910
Mailing Address - Country:US
Mailing Address - Phone:570-837-2123
Mailing Address - Fax:570-837-2185
Practice Address - Street 1:36 S RIVER RD
Practice Address - Street 2:
Practice Address - City:HALIFAX
Practice Address - State:PA
Practice Address - Zip Code:17032-8614
Practice Address - Country:US
Practice Address - Phone:717-827-3428
Practice Address - Fax:717-827-3437
Is Sole Proprietor?:Yes
Enumeration Date:2018-09-12
Last Update Date:2023-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASP019205363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA713997OtherMEDICARE
PA1035778050001Medicaid