Provider Demographics
NPI:1669366407
Name:LYONS, SAMANTHA JORDAN (FNP-C)
Entity type:Individual
Prefix:
First Name:SAMANTHA
Middle Name:JORDAN
Last Name:LYONS
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3445 TRENARY LN
Mailing Address - Street 2:
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80918-3043
Mailing Address - Country:US
Mailing Address - Phone:719-623-9286
Mailing Address - Fax:
Practice Address - Street 1:4145 BRIARGATE PKWY
Practice Address - Street 2:
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80920-7843
Practice Address - Country:US
Practice Address - Phone:855-718-5251
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-06-05
Last Update Date:2025-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO10008672083A0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2083A0300XAllopathic & Osteopathic PhysiciansPreventive MedicineAddiction Medicine