1538153945 NPI number — KAREN CARTER LYON PHD RN CNS

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1538153945 NPI number — KAREN CARTER LYON PHD RN CNS

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
LYON
Provider First Name:
KAREN
Provider Middle Name:
CARTER
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
PHD RN CNS
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1538153945
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
10/29/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
4006 MRSNY CT
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SPRING
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
77386-2072
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
713-794-2882
Provider Business Mailing Address Fax Number:
713-794-2103

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
605 HOLDERRIETH BLVD
Provider Second Line Business Practice Location Address:
WOUND CENTER
Provider Business Practice Location Address City Name:
TOMBALL
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
77375-6445
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
281-401-7943
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
08/31/2005

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 364SM0705X , with the licence number:  232773 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 089369501 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".
  • Identifier: Q3561 , issued by the state of ( NM ) . This identifiers is of the category "MEDICAID".




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