Provider Demographics
NPI:1023303922
Name:LYLES MCKELVY, STARLA N (DO)
Entity type:Individual
Prefix:MRS
First Name:STARLA
Middle Name:N
Last Name:LYLES MCKELVY
Suffix:
Gender:F
Credentials:DO
Other - Prefix:MRS
Other - First Name:STARLA
Other - Middle Name:NICOLE
Other - Last Name:LYLES
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DO
Mailing Address - Street 1:12625 HESPERIA RD
Mailing Address - Street 2:
Mailing Address - City:VICTORVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:92395-7720
Mailing Address - Country:US
Mailing Address - Phone:209-381-6800
Mailing Address - Fax:760-995-8300
Practice Address - Street 1:12625 HESPERIA RD
Practice Address - Street 2:
Practice Address - City:VICTORVILLE
Practice Address - State:CA
Practice Address - Zip Code:92395-7720
Practice Address - Country:US
Practice Address - Phone:760-995-8300
Practice Address - Fax:760-995-8300
Is Sole Proprietor?:Yes
Enumeration Date:2011-06-20
Last Update Date:2021-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA01022031992084P0800X
CA20A14833261QM0850X, 2084P0800X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Single Specialty
No261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental HealthGroup - Single Specialty
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training ProgramGroup - Single Specialty