Provider Demographics
NPI:1902424930
Name:LYONS, MIKAYLA (APRN)
Entity Type:Individual
Prefix:
First Name:MIKAYLA
Middle Name:
Last Name:LYONS
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 1:2253 OLYMPIC ST STE B
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:OH
Mailing Address - Zip Code:45503-2736
Mailing Address - Country:US
Mailing Address - Phone:937-419-0920
Mailing Address - Fax:937-717-1663
Practice Address - Street 1:2253 OLYMPIC ST STE B
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:OH
Practice Address - Zip Code:45503-2736
Practice Address - Country:US
Practice Address - Phone:937-419-0920
Practice Address - Fax:937-717-1663
Is Sole Proprietor?:Yes
Enumeration Date:2020-07-07
Last Update Date:2022-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHRN.430631163W00000X
OHAPRN.CNP.363LF0000X
OHAPRN.CNP.0031475363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No163W00000XNursing Service ProvidersRegistered Nurse
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily