Provider Demographics
NPI:1356986004
Name:LYONS, TENNIE (RN)
Entity type:Individual
Prefix:
First Name:TENNIE
Middle Name:
Last Name:LYONS
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8450 BEA LN
Mailing Address - Street 2:
Mailing Address - City:GREENWOOD
Mailing Address - State:LA
Mailing Address - Zip Code:71033-3302
Mailing Address - Country:US
Mailing Address - Phone:903-345-4545
Mailing Address - Fax:903-270-7520
Practice Address - Street 1:2621 N WOODLOCH ST
Practice Address - Street 2:
Practice Address - City:CONROE
Practice Address - State:TX
Practice Address - Zip Code:77385-8581
Practice Address - Country:US
Practice Address - Phone:903-345-4545
Practice Address - Fax:903-270-7520
Is Sole Proprietor?:Yes
Enumeration Date:2019-11-16
Last Update Date:2020-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX595748163W00000X, 163WC0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes163WC0400XNursing Service ProvidersRegistered NurseCase ManagementGroup - Multi-Specialty
No163W00000XNursing Service ProvidersRegistered NurseGroup - Multi-Specialty