Provider Demographics
NPI:1639654031
Name:LYLES, SARAH ELIZABETH (LVN)
Entity Type:Individual
Prefix:
First Name:SARAH
Middle Name:ELIZABETH
Last Name:LYLES
Suffix:
Gender:F
Credentials:LVN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:613 COUNTY ROAD 4415
Mailing Address - Street 2:
Mailing Address - City:TENAHA
Mailing Address - State:TX
Mailing Address - Zip Code:75974-3041
Mailing Address - Country:US
Mailing Address - Phone:318-880-2674
Mailing Address - Fax:
Practice Address - Street 1:613 COUNTY ROAD 4415
Practice Address - Street 2:
Practice Address - City:TENAHA
Practice Address - State:TX
Practice Address - Zip Code:75974-3041
Practice Address - Country:US
Practice Address - Phone:318-880-2674
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-10-02
Last Update Date:2018-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX336558164X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164X00000XNursing Service ProvidersLicensed Vocational Nurse