Provider Demographics
NPI:1124614839
Name:LYON HEALTHCARE SERVICES LLC
Entity type:Organization
Organization Name:LYON HEALTHCARE SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:KAMILAH
Authorized Official - Middle Name:J
Authorized Official - Last Name:PAYNE
Authorized Official - Suffix:
Authorized Official - Credentials:FNP-C
Authorized Official - Phone:346-442-6856
Mailing Address - Street 1:15318 ABOYNE LN
Mailing Address - Street 2:
Mailing Address - City:HUMBLE
Mailing Address - State:TX
Mailing Address - Zip Code:77346-4611
Mailing Address - Country:US
Mailing Address - Phone:346-442-6856
Mailing Address - Fax:
Practice Address - Street 1:525 N SAM HOUSTON PKWY E STE 245
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77060-4016
Practice Address - Country:US
Practice Address - Phone:832-616-0698
Practice Address - Fax:713-513-5737
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-12-16
Last Update Date:2025-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary CareGroup - Multi-Specialty
No163WW0000XNursing Service ProvidersRegistered NurseWound CareGroup - Multi-Specialty
No207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1417503624Medicaid