Provider Demographics
NPI:1891090056
Name:LYONS, MIRANDA B (PA-C)
Entity Type:Individual
Prefix:
First Name:MIRANDA
Middle Name:B
Last Name:LYONS
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:85 TOWER CIR
Mailing Address - Street 2:
Mailing Address - City:SOMERSET
Mailing Address - State:KY
Mailing Address - Zip Code:42503-3476
Mailing Address - Country:US
Mailing Address - Phone:606-772-3376
Mailing Address - Fax:606-677-0335
Practice Address - Street 1:85 TOWER CIR
Practice Address - Street 2:
Practice Address - City:SOMERSET
Practice Address - State:KY
Practice Address - Zip Code:42503-3476
Practice Address - Country:US
Practice Address - Phone:606-772-3376
Practice Address - Fax:606-677-0335
Is Sole Proprietor?:No
Enumeration Date:2011-01-20
Last Update Date:2011-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KYPA1591363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant