Active NPI
Julie Louise Lyerla, PAC
- Physician Assistant
- Edgerton, WI
National Provider Identifier
1700977956
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physician Assistant
- License
- 409023
- Practice address
- 528 Stoughton Rd
Suite 2
Edgerton, WI 53534-1137 - Phone
- (608) 884-2544
- Fax
- (608) 884-2912
- NPI assigned
- Sep 27, 2006
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physician Assistant | 363A00000X | 409023 | WI | Primary |
Addresses
Primary practice location
528 Stoughton Rd
Suite 2
Edgerton, WI 53534-1137
Mailing address
528 Stoughton Rd
Suite 2
Edgerton, WI 53534-1137
Phone (608) 884-2544
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 32445200 | Medicaid | WI |
Other names 1
- Julie Lyon
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 409023 | WI | MD | Physician Assistant |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1159315200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1700977956",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "528 STOUGHTON RD",
"address_2": "SUITE 2",
"city": "EDGERTON",
"state": "WI",
"postal_code": "535341137",
"telephone_number": "608-884-2544",
"fax_number": "608-884-2912"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "528 STOUGHTON RD",
"address_2": "SUITE 2",
"city": "EDGERTON",
"state": "WI",
"postal_code": "535341137",
"telephone_number": "608-884-2544",
"fax_number": "608-884-2912"
}
],
"practiceLocations": [],
"basic": {
"last_name": "LYERLA",
"first_name": "JULIE",
"middle_name": "LOUISE",
"name_prefix": "Mrs.",
"credential": "PAC",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2006-09-27",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "363A00000X",
"taxonomy_group": "",
"desc": "Physician Assistant",
"state": "WI",
"license": "409023",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "32445200",
"state": "WI"
}
],
"endpoints": [],
"other_names": [
{
"first_name": "JULIE",
"last_name": "LYON",
"code": "1",
"type": "Former Name"
}
]
}Other providers in Edgerton, WI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.