Individual
TRACI M LYONS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
14535A HAZEL DELL PKWY, CARMEL, IN 46033-9401
(317) 770-3777
(317) 705-4391
Mailing address
16086 TENOR WAY, NOBLESVILLE, IN 46060-9287
(317) 435-3147
Taxonomy
Speciality
Code
Description
License number
State
363AS0400X
Surgical Physician Assistant
Primary
10001601A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
300009159
—
IN
Enumeration date
10/28/2013
Last updated
03/30/2021
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