Provider Demographics
NPI:1265764310
Name:LYLE, JODY B (CRNA)
Entity type:Individual
Prefix:MRS
First Name:JODY
Middle Name:B
Last Name:LYLE
Suffix:
Gender:F
Credentials:CRNA
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Mailing Address - Street 1:860 OMNI BLVD STE 303
Mailing Address - Street 2:
Mailing Address - City:NEWPORT NEWS
Mailing Address - State:VA
Mailing Address - Zip Code:23606-4477
Mailing Address - Country:US
Mailing Address - Phone:757-232-8769
Mailing Address - Fax:757-232-8875
Practice Address - Street 1:5424 DISCOVERY PARK BOULEVARD
Practice Address - Street 2:BLDG. A, SUITE 101
Practice Address - City:WILLIAMSBURG
Practice Address - State:VA
Practice Address - Zip Code:23188
Practice Address - Country:US
Practice Address - Phone:757-707-3505
Practice Address - Fax:757-707-3506
Is Sole Proprietor?:No
Enumeration Date:2010-01-31
Last Update Date:2018-03-17
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
VA0024168627367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered