Provider Demographics
NPI:1972602498
Name:LYON, KERRY HARTMAN (MA)
Entity Type:Individual
Prefix:MRS
First Name:KERRY
Middle Name:HARTMAN
Last Name:LYON
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1500 N MESA ST
Mailing Address - Street 2:
Mailing Address - City:EL PASO
Mailing Address - State:TX
Mailing Address - Zip Code:79902-4019
Mailing Address - Country:US
Mailing Address - Phone:913-532-6935
Mailing Address - Fax:915-532-6289
Practice Address - Street 1:1500 N MESA ST
Practice Address - Street 2:
Practice Address - City:EL PASO
Practice Address - State:TX
Practice Address - Zip Code:79902-4019
Practice Address - Country:US
Practice Address - Phone:913-532-6935
Practice Address - Fax:915-532-6289
Is Sole Proprietor?:No
Enumeration Date:2006-09-21
Last Update Date:2009-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX50929237600000X
NM2143237600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237600000XSpeech, Language and Hearing Service ProvidersAudiologist-Hearing Aid Fitter
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX0220857-01Medicaid
TX80188AMedicare ID - Type Unspecified