Provider Demographics
NPI:1568896165
Name:LYLE, LANA JILL (FNP)
Entity Type:Individual
Prefix:MRS
First Name:LANA
Middle Name:JILL
Last Name:LYLE
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1326
Mailing Address - Street 2:
Mailing Address - City:STARKVILLE
Mailing Address - State:MS
Mailing Address - Zip Code:39760-1326
Mailing Address - Country:US
Mailing Address - Phone:662-615-2830
Mailing Address - Fax:662-615-2836
Practice Address - Street 1:107 DOCTORS PARK
Practice Address - Street 2:
Practice Address - City:STARKVILLE
Practice Address - State:MS
Practice Address - Zip Code:39759-2174
Practice Address - Country:US
Practice Address - Phone:662-615-3751
Practice Address - Fax:662-615-3754
Is Sole Proprietor?:No
Enumeration Date:2013-08-30
Last Update Date:2013-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSR853302363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily