Provider Demographics
NPI:1659615748
Name:LYMAN, KAEL
Entity Type:Individual
Prefix:
First Name:KAEL
Middle Name:
Last Name:LYMAN
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 1:2210 REAGAN AVE APT 308
Mailing Address - Street 2:
Mailing Address - City:ROCK SPRINGS
Mailing Address - State:WY
Mailing Address - Zip Code:82901-4690
Mailing Address - Country:US
Mailing Address - Phone:605-645-0072
Mailing Address - Fax:
Practice Address - Street 1:2210 REAGAN AVE APT 308
Practice Address - Street 2:
Practice Address - City:ROCK SPRINGS
Practice Address - State:WY
Practice Address - Zip Code:82901-4690
Practice Address - Country:US
Practice Address - Phone:605-645-0072
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-11-15
Last Update Date:2022-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator
No172V00000XOther Service ProvidersCommunity Health Worker