Individual provider Active NPI

Jessica Marie Lyons, R.N.,F.N.P.-C

  • Family Nurse Practitioner
  • Tifton, GA
National Provider Identifier
1285009555
Registry record updated Nov 2, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Nurse PractitionerTaxonomy code 363LF0000X
License
RN169668 Issued in GA
Practice address
1909 US Highway 82 W Ste 5
Tifton, GA 31793-8213
Phone
(229) 386-4300
Fax
(229) 386-8300
NPI assigned
Dec 11, 2015
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Nov 2, 2023

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Nurse Practitioner 363LF0000X RN169668 GA Primary

Addresses

Primary practice location

1909 US Highway 82 W Ste 5
Tifton, GA 31793-8213

Mailing address

1909 US Highway 82 W Ste 5
Tifton, GA 31793-8213
Phone (229) 386-4300

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in GA
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20160201002271 GA Practitioner - Nurse Practitioner 7315241072 Reassigns benefits to 1 organization

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Registered Nurse

State licenses

LicenseStateTypeSpecialty
RN169668GAMDFamily Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Ich Physician Group CurrentSince Mar 1, 2020 Accepting new patients
Ich Physician Group CurrentSince Mar 1, 2020 Accepting new patients
Tift Regional Health System Inc CurrentSince Feb 3, 2016 Accepting new patients

Locations

357 Cargile Rd
Ocilla, GA 31774
Phone (229) 468-3800

361 Cargile Rd
Ocilla, GA 31774
Phone (229) 468-3975

710 N Irwin Ave
Ocilla, GA 31774
Phone (229) 468-3800

2225 US Highway 41 N
Tifton, GA 31794
Phone (229) 353-3422

Organizations & group practices 3

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1449792000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1698883200000",
    "number": "1285009555",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1909 US HIGHWAY 82 W STE 5",
            "city": "TIFTON",
            "state": "GA",
            "postal_code": "317938213",
            "telephone_number": "229-386-4300",
            "fax_number": "229-386-8300"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1909 US HIGHWAY 82 W STE 5",
            "city": "TIFTON",
            "state": "GA",
            "postal_code": "317938213",
            "telephone_number": "229-386-4300",
            "fax_number": "229-386-8300"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "LYONS",
        "first_name": "JESSICA",
        "middle_name": "MARIE",
        "credential": "R.N.,F.N.P.-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2015-12-11",
        "last_updated": "2023-11-02",
        "certification_date": "2023-11-02",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "GA",
            "license": "RN169668",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Tifton, GA

Sources for this page

Verify at the official NPI Registry.