Provider Demographics
NPI:1518280924
Name:LYONS, KELLY KAY
Entity Type:Individual
Prefix:
First Name:KELLY
Middle Name:KAY
Last Name:LYONS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:308 S CESAR CHAVEZ AVE
Mailing Address - Street 2:
Mailing Address - City:CRYSTAL CITY
Mailing Address - State:TX
Mailing Address - Zip Code:78839-4200
Mailing Address - Country:US
Mailing Address - Phone:830-374-2301
Mailing Address - Fax:830-374-3364
Practice Address - Street 1:308 S CESAR CHAVEZ AVE
Practice Address - Street 2:
Practice Address - City:CRYSTAL CITY
Practice Address - State:TX
Practice Address - Zip Code:78839-4200
Practice Address - Country:US
Practice Address - Phone:830-374-2301
Practice Address - Fax:830-374-3364
Is Sole Proprietor?:No
Enumeration Date:2010-03-12
Last Update Date:2010-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX11232124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist