Provider Demographics
NPI:1538684535
Name:LYON, AMY JO (APRN)
Entity Type:Individual
Prefix:
First Name:AMY
Middle Name:JO
Last Name:LYON
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:AMY
Other - Middle Name:JO
Other - Last Name:HAYCOCK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 1028
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:NE
Mailing Address - Zip Code:68602-1028
Mailing Address - Country:US
Mailing Address - Phone:402-562-7500
Mailing Address - Fax:402-564-0611
Practice Address - Street 1:4321 41ST AVE
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:NE
Practice Address - Zip Code:68601-2131
Practice Address - Country:US
Practice Address - Phone:402-562-7500
Practice Address - Fax:402-564-0611
Is Sole Proprietor?:No
Enumeration Date:2017-08-10
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE112306363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner