Active NPI
Lisa Gallishaw Lyon, PA-C
- Physician Assistant
- Pahoa, HI
National Provider Identifier
1821360819
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physician Assistant
- License
- AMD 366
- Practice address
- 15-2662 Pahoa Village Rd
Suite 303 PMB 8741
Pahoa, HI 96778-7730 - Phone
- (808) 930-6001
- NPI assigned
- Feb 6, 2012
- 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 | AMD 366 | HI | Primary |
Addresses
Primary practice location
15-2662 Pahoa Village Rd
Suite 303 PMB 8741
Pahoa, HI 96778-7730
Mailing address
350 Sumner St
Sumner Wellness Clinic
Honolulu, HI 96817-5088
Phone (808) 477-2925
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)
- Enrolled
- Credentials
- Physician Assistant
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| AMD 366 | HI | MD | Physician Assistant |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1328486400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1425513600000",
"number": "1821360819",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "350 SUMNER ST",
"address_2": "SUMNER WELLNESS CLINIC",
"city": "HONOLULU",
"state": "HI",
"postal_code": "968175088",
"telephone_number": "808-477-2925",
"fax_number": "808-537-2697"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "15-2662 PAHOA VILLAGE RD",
"address_2": "SUITE 303 PMB 8741",
"city": "PAHOA",
"state": "HI",
"postal_code": "967787730",
"telephone_number": "808-930-6001"
}
],
"practiceLocations": [],
"basic": {
"last_name": "LYON",
"first_name": "LISA",
"middle_name": "GALLISHAW",
"credential": "PA-C",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2012-02-06",
"last_updated": "2015-03-05",
"status": "A"
},
"taxonomies": [
{
"code": "363A00000X",
"taxonomy_group": "",
"desc": "Physician Assistant",
"state": "HI",
"license": "AMD 366",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Pahoa, HI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 5, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.