Active NPI
Renee C Lyon, ARNP
- Family Nurse Practitioner
- University Place, WA
National Provider Identifier
1922190651
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Family Nurse Practitioner
- License
- AP30007419
- Practice address
- 4401 Bridgeport Way W
University Place, WA 98466-4201 - Phone
- (253) 564-4157
- Fax
- (253) 564-4813
- NPI assigned
- Sep 29, 2006
- Last updated
- Sep 5, 2014
- 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 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Family Nurse Practitioner | 363LF0000X | AP30007419 | WA | Primary |
| Registered Nurse | 163W00000X | RN00157089 | WA |
Addresses
Primary practice location
4401 Bridgeport Way W
University Place, WA 98466-4201
Mailing address
4401 Bridgeport Way W
University Place, WA 98466-4201
Phone (253) 564-4157
Other identifiers 5
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 0213407 | Other | WA | STATE L&I |
| 9650235 | Medicaid | WA | |
| 8943195 | Other | WA | STATE CRIME VICTIMS |
| 0222891 | Other | WA | STATE L&I |
| 8945094 | Other | WA | STATE CRIME VICTIMS |
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
- Nurse Practitioner
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1159488000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1409875200000",
"number": "1922190651",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "4401 BRIDGEPORT WAY W",
"city": "UNIVERSITY PLACE",
"state": "WA",
"postal_code": "984664201",
"telephone_number": "253-564-4157",
"fax_number": "253-564-4813"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "4401 BRIDGEPORT WAY W",
"city": "UNIVERSITY PLACE",
"state": "WA",
"postal_code": "984664201",
"telephone_number": "253-564-4157",
"fax_number": "253-564-4813"
}
],
"practiceLocations": [],
"basic": {
"last_name": "LYON",
"first_name": "RENEE",
"middle_name": "C",
"credential": "ARNP",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2006-09-29",
"last_updated": "2014-09-05",
"status": "A"
},
"taxonomies": [
{
"code": "363LF0000X",
"taxonomy_group": "",
"desc": "Nurse Practitioner, Family",
"state": "WA",
"license": "AP30007419",
"primary": true
},
{
"code": "163W00000X",
"taxonomy_group": "",
"desc": "Registered Nurse",
"state": "WA",
"license": "RN00157089",
"primary": false
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "STATE L&I",
"identifier": "0213407",
"state": "WA"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "9650235",
"state": "WA"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "STATE CRIME VICTIMS",
"identifier": "8943195",
"state": "WA"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "STATE L&I",
"identifier": "0222891",
"state": "WA"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "STATE CRIME VICTIMS",
"identifier": "8945094",
"state": "WA"
}
],
"endpoints": [],
"other_names": []
}Other providers in University Place, WA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 5, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.