Provider Demographics
NPI:1497911440
Name:LYON, KAREY MARLENE (NP-C)
Entity Type:Individual
Prefix:MRS
First Name:KAREY
Middle Name:MARLENE
Last Name:LYON
Suffix:
Gender:F
Credentials:NP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13217 68TH AVE NW
Mailing Address - Street 2:
Mailing Address - City:CASS LAKE
Mailing Address - State:MN
Mailing Address - Zip Code:56633-9734
Mailing Address - Country:US
Mailing Address - Phone:218-335-0050
Mailing Address - Fax:
Practice Address - Street 1:115 6TH ST NE
Practice Address - Street 2:SUITE E
Practice Address - City:CASS LAKE
Practice Address - State:MN
Practice Address - Zip Code:56633-3428
Practice Address - Country:US
Practice Address - Phone:218-335-4500
Practice Address - Fax:218-335-8219
Is Sole Proprietor?:No
Enumeration Date:2008-07-30
Last Update Date:2008-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXF 1104211363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily