Provider Demographics
NPI:1922750264
Name:LYON, KELLI (APRN)
Entity Type:Individual
Prefix:
First Name:KELLI
Middle Name:
Last Name:LYON
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:145 MAYFAIR CT
Mailing Address - Street 2:
Mailing Address - City:SANFORD
Mailing Address - State:FL
Mailing Address - Zip Code:32771-7707
Mailing Address - Country:US
Mailing Address - Phone:317-502-6236
Mailing Address - Fax:
Practice Address - Street 1:145 MAYFAIR CT
Practice Address - Street 2:
Practice Address - City:SANFORD
Practice Address - State:FL
Practice Address - Zip Code:32771-7707
Practice Address - Country:US
Practice Address - Phone:317-502-6236
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-01-18
Last Update Date:2023-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAPRN11023074363LF0000X
IN28197195A363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily