Provider Demographics
NPI:1184472359
Name:CONN-LYONS, BRANDI NICHOLE
Entity type:Individual
Prefix:
First Name:BRANDI
Middle Name:NICHOLE
Last Name:CONN-LYONS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5005 STATE HIGHWAY 194 W
Mailing Address - Street 2:
Mailing Address - City:PIKEVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:41501-6330
Mailing Address - Country:US
Mailing Address - Phone:606-616-8206
Mailing Address - Fax:
Practice Address - Street 1:5005 STATE HIGHWAY 194 W
Practice Address - Street 2:
Practice Address - City:PIKEVILLE
Practice Address - State:KY
Practice Address - Zip Code:41501-6330
Practice Address - Country:US
Practice Address - Phone:606-437-4706
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-05-10
Last Update Date:2024-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY4020431363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner