Provider Demographics
NPI:1578193561
Name:LYLE, ELYSHA DAWN (PA-C)
Entity Type:Individual
Prefix:
First Name:ELYSHA
Middle Name:DAWN
Last Name:LYLE
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
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Other - Last Name:
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Mailing Address - Street 1:8302 WESTOWN PKWY UNIT 9109
Mailing Address - Street 2:
Mailing Address - City:WEST DES MOINES
Mailing Address - State:IA
Mailing Address - Zip Code:50266-1615
Mailing Address - Country:US
Mailing Address - Phone:641-660-4632
Mailing Address - Fax:
Practice Address - Street 1:877 JEFFERSON AVE
Practice Address - Street 2:
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38103-2807
Practice Address - Country:US
Practice Address - Phone:901-545-8090
Practice Address - Fax:901-545-6809
Is Sole Proprietor?:Yes
Enumeration Date:2020-01-19
Last Update Date:2021-01-12
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
TN4293363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical